Individual
SOWMYA MYSORE RAJAGOPAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2180 W KIMBERLY RD SPC 8, DAVENPORT, IA 52806-5368
(855) 505-2378
Mailing address
1601 WALTON DR, WACO, TX 76705-2468
(408) 505-4155
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019.030471
IL
1223G0001X
General Practice Dentistry
09224
IA
1223G0001X
General Practice Dentistry
Primary
30536
TX
1223G0001X
General Practice Dentistry
DDS63691
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598759029
—
IA
05
—
PENDING
—
IL
Enumeration date
07/29/2014
Last updated
11/21/2017
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