Provider Demographics
NPI:1699162677
Name:GANGULY, RUMPA (DMD)
Entity type:Individual
Prefix:DR
First Name:RUMPA
Middle Name:
Last Name:GANGULY
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 1:30 BRUCEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4422
Mailing Address - Country:US
Mailing Address - Phone:978-266-2723
Mailing Address - Fax:
Practice Address - Street 1:30 BRUCEWOOD RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4422
Practice Address - Country:US
Practice Address - Phone:978-266-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18562971223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology