Individual
DR. SHANTI GOPALAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
13347 ENTREKEN AVE, SAN DIEGO, CA 92129-2353
(858) 740-6977
Mailing address
13347 ENTREKEN AVE, SAN DIEGO, CA 92129-2353
(858) 740-6977
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
55853
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D7103
—
AZ
Enumeration date
01/31/2007
Last updated
03/17/2018
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