Provider Demographics
NPI:1720770878
Name:GOPALAKRISHNAN, POORNIMA (DDS)
Entity type:Individual
Prefix:
First Name:POORNIMA
Middle Name:
Last Name:GOPALAKRISHNAN
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 1:18 DUNIA LN UNIT 18
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2461
Mailing Address - Country:US
Mailing Address - Phone:540-632-8198
Mailing Address - Fax:
Practice Address - Street 1:14 COMMERCIAL RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3338
Practice Address - Country:US
Practice Address - Phone:978-840-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18598971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice