Provider Demographics
NPI:1881772127
Name:GOWDA, RESHMA M (DDS)
Entity type:Individual
Prefix:
First Name:RESHMA
Middle Name:M
Last Name:GOWDA
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 1:2950 E WATTLES RD
Mailing Address - Street 2:STE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-7008
Mailing Address - Country:US
Mailing Address - Phone:248-526-9680
Mailing Address - Fax:
Practice Address - Street 1:2950 E WATTLES RD
Practice Address - Street 2:STE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-7008
Practice Address - Country:US
Practice Address - Phone:248-526-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315008675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist