Provider Demographics
NPI:1942377460
Name:GAMPA, RAVINDER K (DBS)
Entity Type:Individual
Prefix:DR
First Name:RAVINDER
Middle Name:K
Last Name:GAMPA
Suffix:
Gender:M
Credentials:DBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9369 PARAGON MILLS LANE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-885-4894
Mailing Address - Fax:
Practice Address - Street 1:5515 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-2803
Practice Address - Country:US
Practice Address - Phone:937-294-0468
Practice Address - Fax:937-294-4266
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH212331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2416353Medicaid