Provider Demographics
NPI:1568035301
Name:GOLWALA, YESHA KIRANKUMAR (DDS)
Entity Type:Individual
Prefix:
First Name:YESHA KIRANKUMAR
Middle Name:
Last Name:GOLWALA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1433
Mailing Address - Country:US
Mailing Address - Phone:954-516-8289
Mailing Address - Fax:
Practice Address - Street 1:2811 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1433
Practice Address - Country:US
Practice Address - Phone:954-516-8289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist