Individual
GOPALAKRISHNA K VASTARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
206 EAST ROUTE 59, NANUET, NY 10954
(845) 623-4435
(845) 623-0415
Mailing address
206 EAST ROUTE 59, NANUET, NY 10954
(845) 623-4435
(845) 623-0415
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
040649
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00998247
—
NY
Enumeration date
10/16/2006
Last updated
07/08/2007
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