| NPI | 1073954657 |
|---|---|
| Former Name | BALKRISHNA RAMESH GANTYALA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856347) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1856347) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2018-09-12 |