Provider Demographics
NPI:1942740006
Name:JOSHI, DHWANI M (DMD)
Entity Type:Individual
Prefix:
First Name:DHWANI
Middle Name:M
Last Name:JOSHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S WAUKEGAN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2672
Mailing Address - Country:US
Mailing Address - Phone:847-412-8808
Mailing Address - Fax:
Practice Address - Street 1:810 S WAUKEGAN RD STE 101
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2672
Practice Address - Country:US
Practice Address - Phone:847-615-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0314941223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty