Provider Demographics
NPI:1992012074
Name:AWASTHI, MOHANA RATNA SHILPA (DDS)
Entity Type:Individual
Prefix:
First Name:MOHANA
Middle Name:RATNA SHILPA
Last Name:AWASTHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MOHANA
Other - Middle Name:RATNA SHILPA
Other - Last Name:AWASTHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:17535 SODA SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-8653
Mailing Address - Country:US
Mailing Address - Phone:774-208-3880
Mailing Address - Fax:
Practice Address - Street 1:1588 SOQUEL DR STE 3
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1714
Practice Address - Country:US
Practice Address - Phone:831-454-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist