Individual
DR. SHARAVANA KUMAR GAJAPATHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S, M.P.H
Contact information
Practice address
1115 US HIGHWAY 259 S, HENDERSON, TX 75654-3629
(903) 392-8251
Mailing address
1115 US HIGHWAY 259 S, HENDERSON, TX 75654-3629
(903) 392-8251
(903) 392-8207
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
24289
TX
122300000X
Dentist
D12360
MN
1223P0221X
Pediatric Dentistry
Primary
24289
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203375501
—
TX
05
—
206661513
—
TX
Enumeration date
10/23/2007
Last updated
07/01/2020
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