Provider Demographics
NPI:1487609327
Name:SAPOVADIA, PARIMAL G (DMD)
Entity type:Individual
Prefix:DR
First Name:PARIMAL
Middle Name:G
Last Name:SAPOVADIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 PLAINFIELD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0739
Mailing Address - Country:US
Mailing Address - Phone:608-373-5995
Mailing Address - Fax:608-531-2680
Practice Address - Street 1:1703 PLAINFIELD AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545
Practice Address - Country:US
Practice Address - Phone:608-373-5995
Practice Address - Fax:608-531-2680
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5943-0151223S0112X
IL0190281591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI454747870OtherTIN