Provider Demographics
NPI:1518396621
Name:GARG, SHIVALI GOHEL (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:SHIVALI
Middle Name:GOHEL
Last Name:GARG
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:DR
Other - First Name:SHIVALI
Other - Middle Name:
Other - Last Name:GOHEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MSD
Mailing Address - Street 1:4320 GENESEE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4900
Mailing Address - Country:US
Mailing Address - Phone:858-541-7676
Mailing Address - Fax:
Practice Address - Street 1:4320 GENESEE AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117
Practice Address - Country:US
Practice Address - Phone:858-541-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA629581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics