Provider Demographics
NPI:1669595088
Name:GOWDA, ASHWATH M (D D S)
Entity type:Individual
Prefix:DR
First Name:ASHWATH
Middle Name:M
Last Name:GOWDA
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:MUNISWAMAPPA
Other - Middle Name:
Other - Last Name:ASWATHAIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 10655
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91510-0655
Mailing Address - Country:US
Mailing Address - Phone:818-848-0680
Mailing Address - Fax:866-610-1553
Practice Address - Street 1:1350 W GONZALES RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3365
Practice Address - Country:US
Practice Address - Phone:818-848-0680
Practice Address - Fax:866-610-1553
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS26029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist