Provider Demographics
NPI:1881347540
Name:GAIKWAD, JUI SIDDHARTH
Entity type:Individual
Prefix:
First Name:JUI
Middle Name:SIDDHARTH
Last Name:GAIKWAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUI
Other - Middle Name:MADHUKAR
Other - Last Name:KARANJKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5009 W GUNNISON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4852
Mailing Address - Country:US
Mailing Address - Phone:234-303-6284
Mailing Address - Fax:
Practice Address - Street 1:6430 GREEN BAY RD STE 112
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2948
Practice Address - Country:US
Practice Address - Phone:262-653-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002750-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist