Provider Demographics
NPI:1245510106
Name:GOVINDARAJAN, RUPA (BDS,DMD)
Entity type:Individual
Prefix:
First Name:RUPA
Middle Name:
Last Name:GOVINDARAJAN
Suffix:
Gender:F
Credentials:BDS,DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SAM BASS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2001
Mailing Address - Country:US
Mailing Address - Phone:512-341-3200
Mailing Address - Fax:512-341-3228
Practice Address - Street 1:1715 S MAYS ST
Practice Address - Street 2:SUITE E
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6740
Practice Address - Country:US
Practice Address - Phone:512-248-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX286991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice