Provider Demographics
NPI:1831432616
Name:BHAVE, ASHWINI SHIRISH (BDS, MDS)
Entity type:Individual
Prefix:
First Name:ASHWINI
Middle Name:SHIRISH
Last Name:BHAVE
Suffix:
Gender:F
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23382 PORTAGE WAY
Mailing Address - Street 2:APT. 2105
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3297
Mailing Address - Country:US
Mailing Address - Phone:909-557-3009
Mailing Address - Fax:
Practice Address - Street 1:2700 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2576
Practice Address - Country:US
Practice Address - Phone:313-494-6780
Practice Address - Fax:313-494-6781
Is Sole Proprietor?:No
Enumeration Date:2013-03-31
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZA-14265122300000X
MI2901021409122300000X
WADE60351086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist