Provider Demographics
NPI:1689691560
Name:BHOSALE-MOHITE, GAYATRI (DDS MS MS)
Entity Type:Individual
Prefix:MRS
First Name:GAYATRI
Middle Name:
Last Name:BHOSALE-MOHITE
Suffix:
Gender:F
Credentials:DDS MS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8507
Mailing Address - Country:US
Mailing Address - Phone:920-730-0345
Mailing Address - Fax:
Practice Address - Street 1:4660 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8507
Practice Address - Country:US
Practice Address - Phone:920-730-0345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry