Provider Demographics
NPI:1669873287
Name:GHOSH, GARGI BAKSHI (DDS)
Entity type:Individual
Prefix:DR
First Name:GARGI
Middle Name:BAKSHI
Last Name:GHOSH
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 1:500 W MONTGOMERY ST STE B
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-8827
Mailing Address - Country:US
Mailing Address - Phone:936-701-5010
Mailing Address - Fax:
Practice Address - Street 1:500 W MONTGOMERY ST STE B
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-8827
Practice Address - Country:US
Practice Address - Phone:936-701-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice