Provider Demographics
NPI:1659115111
Name:SHRESTHA, ANISHMA (DDS)
Entity type:Individual
Prefix:
First Name:ANISHMA
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 CHAMPAIGN RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3203
Mailing Address - Country:US
Mailing Address - Phone:857-445-1477
Mailing Address - Fax:
Practice Address - Street 1:250 S MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-4725
Practice Address - Country:US
Practice Address - Phone:540-552-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist