Provider Demographics
NPI:1952085789
Name:AGHI, ISHITA (DDS)
Entity type:Individual
Prefix:
First Name:ISHITA
Middle Name:
Last Name:AGHI
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 1:19331 W SOUTHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53146-1344
Mailing Address - Country:US
Mailing Address - Phone:262-345-7707
Mailing Address - Fax:
Practice Address - Street 1:107 N CROSBY AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3333
Practice Address - Country:US
Practice Address - Phone:608-752-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001180-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist