Provider Demographics
NPI:1710362108
Name:RUPANI, MALLIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MALLIKA
Middle Name:
Last Name:RUPANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 E FRANKLIN BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-9448
Mailing Address - Country:US
Mailing Address - Phone:704-867-0453
Mailing Address - Fax:
Practice Address - Street 1:2924 E FRANKLIN BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-9448
Practice Address - Country:US
Practice Address - Phone:704-867-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice