Provider Demographics
NPI:1689349763
Name:GODHIA, KISHEN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KISHEN
Middle Name:D
Last Name:GODHIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 DELPY VIEW PT
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4837
Mailing Address - Country:US
Mailing Address - Phone:858-248-7013
Mailing Address - Fax:
Practice Address - Street 1:25270 MARGUERITE PKWY STE C
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2910
Practice Address - Country:US
Practice Address - Phone:949-209-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist