Provider Demographics
NPI:1306681416
Name:GOPAGANI, KARTHIKA DEVI
Entity type:Individual
Prefix:
First Name:KARTHIKA
Middle Name:DEVI
Last Name:GOPAGANI
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 1:12549 S KERRY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9610
Mailing Address - Country:US
Mailing Address - Phone:309-703-5521
Mailing Address - Fax:
Practice Address - Street 1:1568 W OGDEN AVE STE 108
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4090
Practice Address - Country:US
Practice Address - Phone:630-447-9997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0351191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty