Provider Demographics
NPI:1669164364
Name:GHEEWALA, KRISHNA ANIL (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:ANIL
Last Name:GHEEWALA
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 1:3440 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2725
Mailing Address - Country:US
Mailing Address - Phone:580-743-1003
Mailing Address - Fax:
Practice Address - Street 1:8811 E RENO AVE STE 103
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7726
Practice Address - Country:US
Practice Address - Phone:405-732-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7704122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist