Provider Demographics
NPI:1023615796
Name:GOGENENI, HIMABINDU (DDS)
Entity type:Individual
Prefix:DR
First Name:HIMABINDU
Middle Name:
Last Name:GOGENENI
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 1:804 BLAKE ST APT A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2978
Mailing Address - Country:US
Mailing Address - Phone:216-556-2844
Mailing Address - Fax:
Practice Address - Street 1:3575 PORTAGE AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-6092
Practice Address - Country:US
Practice Address - Phone:574-349-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013496A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist