Provider Demographics
NPI:1669166088
Name:DHOLU, PRIYANKA HARDIK (DMD)
Entity type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:HARDIK
Last Name:DHOLU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-0097
Mailing Address - Country:US
Mailing Address - Phone:317-993-7635
Mailing Address - Fax:
Practice Address - Street 1:5470 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1620
Practice Address - Country:US
Practice Address - Phone:317-993-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014128A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice