Provider Demographics
NPI:1922113794
Name:GANDHI, ROOPA P (BDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ROOPA
Middle Name:P
Last Name:GANDHI
Suffix:
Gender:F
Credentials:BDS, MSD
Other - Prefix:DR
Other - First Name:ROOPA
Other - Middle Name:DEVI
Other - Last Name:PURUSHOTHAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:6935 S ROBERTSDALE WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-7503
Mailing Address - Country:US
Mailing Address - Phone:847-909-9765
Mailing Address - Fax:
Practice Address - Street 1:3494 EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-7403
Practice Address - Country:US
Practice Address - Phone:303-659-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210023431223P0221X
CODEN.002053621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO703777341Medicaid