Provider Demographics
NPI:1326657248
Name:SHRESTHA, PRIYANKA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7822 ROYCE HALL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-9727
Mailing Address - Country:US
Mailing Address - Phone:859-489-4064
Mailing Address - Fax:
Practice Address - Street 1:ASPEN DENTAL
Practice Address - Street 2:8815 CHRISTENBURY PKWY STE 40
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2802
Practice Address - Country:US
Practice Address - Phone:704-264-0253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119641223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice