Provider Demographics
NPI:1649040619
Name:GOVINDOOL, SHARASCHANDRA REDDY (BDS, MDS, MSC, PHD)
Entity type:Individual
Prefix:DR
First Name:SHARASCHANDRA REDDY
Middle Name:
Last Name:GOVINDOOL
Suffix:
Gender:M
Credentials:BDS, MDS, MSC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CAMBRIDGE SQ APT A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4822
Mailing Address - Country:US
Mailing Address - Phone:571-685-0161
Mailing Address - Fax:
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-3602
Practice Address - Fax:716-829-3501
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics