Provider Demographics
NPI:1720392491
Name:DOESCHER, BANSI MITHANI (DMD)
Entity Type:Individual
Prefix:DR
First Name:BANSI
Middle Name:MITHANI
Last Name:DOESCHER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:BANSI
Other - Middle Name:TARUNKANT
Other - Last Name:MITHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1500 JOHN F KENNEDY BLVD STE 1906
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1714
Mailing Address - Country:US
Mailing Address - Phone:215-709-0001
Mailing Address - Fax:215-709-6002
Practice Address - Street 1:1500 JOHN F KENNEDY BLVD STE 1906
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:215-709-0001
Practice Address - Fax:215-709-6002
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024208001223G0001X
PADS0385011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027475260003Medicaid