Provider Demographics
NPI:1629422076
Name:RRG DENTAL, LLC
Entity Type:Organization
Organization Name:RRG DENTAL, LLC
Other - Org Name:PAOLI FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-417-7501
Mailing Address - Street 1:833 N BETHLEHEM PIKE
Mailing Address - Street 2:APT B
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1410 RUSSELL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1200
Practice Address - Country:US
Practice Address - Phone:267-417-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty