Provider Demographics
NPI:1760195341
Name:KHENI, DISHA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DISHA
Middle Name:J
Last Name:KHENI
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 1:132 BARNHILL DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8736
Mailing Address - Country:US
Mailing Address - Phone:858-774-1519
Mailing Address - Fax:
Practice Address - Street 1:5261 ELKHORN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842-2506
Practice Address - Country:US
Practice Address - Phone:800-579-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1082231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice