Individual
GAUTAM GOVITRIKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1335 W TABOR RD, 105, PHILADELPHIA, PA 19141-3038
(215) 548-8080
Mailing address
1335 W TABOR RD, 105, PHILADELPHIA, PA 19141-3038
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS037387
PA
Other
Enumeration date
09/18/2008
Last updated
09/18/2008
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