Provider Demographics
NPI:1952785644
Name:BOPARAI, AVINEET
Entity Type:Individual
Prefix:
First Name:AVINEET
Middle Name:
Last Name:BOPARAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 FERMI PL STE 106
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-9411
Mailing Address - Country:US
Mailing Address - Phone:714-618-4313
Mailing Address - Fax:
Practice Address - Street 1:4515 FERMI PL STE 106
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618
Practice Address - Country:US
Practice Address - Phone:714-618-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist