Provider Demographics
NPI:1710179023
Name:KHATRI, AVANI HIRALAL (DDS)
Entity Type:Individual
Prefix:
First Name:AVANI
Middle Name:HIRALAL
Last Name:KHATRI
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 1:205 VENETIAN CV
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6637
Mailing Address - Country:US
Mailing Address - Phone:207-341-6542
Mailing Address - Fax:
Practice Address - Street 1:297 HIGHWAY 51 STE D
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3423
Practice Address - Country:US
Practice Address - Phone:601-856-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-95111223G0001X
MS3980-181223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice