Provider Demographics
NPI:1669929931
Name:GOPE, USHA (DMD)
Entity type:Individual
Prefix:DR
First Name:USHA
Middle Name:
Last Name:GOPE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ELM CREEK DR APT 404
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5233
Mailing Address - Country:US
Mailing Address - Phone:630-310-6520
Mailing Address - Fax:
Practice Address - Street 1:75 W NORTH AVE
Practice Address - Street 2:SUITE # 400
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-2306
Practice Address - Country:US
Practice Address - Phone:708-562-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3190201121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice