Provider Demographics
NPI:1184764946
Name:UDESHI, TUSHAR (DDS)
Entity type:Individual
Prefix:DR
First Name:TUSHAR
Middle Name:
Last Name:UDESHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 ROUTE 120 UNIT C
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1430
Mailing Address - Country:US
Mailing Address - Phone:516-728-4159
Mailing Address - Fax:
Practice Address - Street 1:367 ROUTE 120 UNIT C
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1430
Practice Address - Country:US
Practice Address - Phone:603-643-4142
Practice Address - Fax:603-643-1740
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051814122300000X
NH04801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02671823Medicaid