Provider Demographics
NPI:1609479724
Name:GOYAL, RUCHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUCHI
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 N RIPON RD UNIT 1008
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9829
Mailing Address - Country:US
Mailing Address - Phone:618-303-8238
Mailing Address - Fax:
Practice Address - Street 1:1663 N RIPON RD UNIT 1008
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-9829
Practice Address - Country:US
Practice Address - Phone:618-303-8238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist