Active NPI
Vikram Ganupur
- General Practice Dentistry
- Clovis, NM
National Provider Identifier
1104104512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DD3568
- Practice address
- 4017 N Prince St
Clovis, NM 88101-9705 - Phone
- (847) 915-3040
- NPI assigned
- Aug 2, 2011
- Last updated
- Aug 2, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD3568 | NM | Primary |
Addresses
Primary practice location
4017 N Prince St
Clovis, NM 88101-9705
Mailing address
2610 Weddington RDG NE
Marietta, GA 30068-2279
Phone (678) 923-1486
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD3568 | NM | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312243200000",
"number": "1104104512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2610 WEDDINGTON RDG NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300682279",
"telephone_number": "678-923-1486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4017 N PRINCE ST",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881019705",
"telephone_number": "847-915-3040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANUPUR",
"first_name": "VIKRAM",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-02",
"last_updated": "2011-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NM",
"license": "DD3568",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.