Sowmya Mysore Rajagopal, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30536 Issued in TX

Practice address

2180 W Kimberly Rd SPC 8
Davenport, IA 52806-5368

Phone

(855) 505-2378

NPI assigned

Jul 29, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511222400000",
    "number": "1801204292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 WALTON DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767052468",
            "telephone_number": "408-505-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 W KIMBERLY RD SPC 8",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528065368",
            "telephone_number": "855-505-2378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYSORE RAJAGOPAL",
        "first_name": "SOWMYA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-29",
        "last_updated": "2017-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "09224",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS63691",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.030471",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "30536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598759029",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy James Murphy, PH.D.
• Muse Creative Arts Therapy LLC
• Bryant A. Mutchler, DO
• Brian Arthur Mykleby, D.D.S.,M.S.
• Connie Colleen Mykleby, CRNA
• Elizabeth Anne Nace
• Ahmad M Nafe, M.D.
• Carter David Nameth, DC
• Rayna C Narvaez, PHD
• Jessica Naughtin

• General Practice Dentistry in Davenport, IA
• Providers in Davenport, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.