Individual
SHOUVIK PONNUSAMY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4010 SANDY BROOK DR STE 204, ROUND ROCK, TX 78665-1518
(512) 456-3161
Mailing address
1511 RIMSTONE DR, CEDAR PARK, TX 78613-7692
(630) 267-1199
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
38050
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/29/2016
Last updated
09/23/2022
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