Provider Demographics
NPI:1932393345
Name:GOPINATHAN, PRIYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:GOPINATHAN
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 1:1214 PARK ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3738
Mailing Address - Country:US
Mailing Address - Phone:781-297-7360
Mailing Address - Fax:781-297-7830
Practice Address - Street 1:1214 PARK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3738
Practice Address - Country:US
Practice Address - Phone:781-297-7360
Practice Address - Fax:781-297-7830
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice