Provider Demographics
NPI:1295116259
Name:BHOSALE-WILMES, PALLAVI (DDS)
Entity type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:BHOSALE-WILMES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PALLAVI
Other - Middle Name:PRATAP
Other - Last Name:BHOSALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1785 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3359 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2928
Practice Address - Country:US
Practice Address - Phone:763-270-5776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist