Provider Demographics
NPI:1457920191
Name:GOHEL, NISHITA SURENDRA
Entity type:Individual
Prefix:DR
First Name:NISHITA
Middle Name:SURENDRA
Last Name:GOHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 WINTER PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1352
Mailing Address - Country:US
Mailing Address - Phone:248-633-5609
Mailing Address - Fax:
Practice Address - Street 1:2701 N DIRKSEN PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-1407
Practice Address - Country:US
Practice Address - Phone:217-492-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist