Provider Demographics
NPI:1649593286
Name:GOVITRIKAR, VRISHALI (DMD)
Entity Type:Individual
Prefix:
First Name:VRISHALI
Middle Name:
Last Name:GOVITRIKAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:VRISHALI
Other - Middle Name:
Other - Last Name:GUJAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:68 SAGAMORE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2978
Mailing Address - Country:US
Mailing Address - Phone:267-303-4093
Mailing Address - Fax:
Practice Address - Street 1:68 SAGAMORE AVE S
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2978
Practice Address - Country:US
Practice Address - Phone:267-303-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0381391223G0001X
NJDI0-24348001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice