Provider Demographics
NPI:1982804936
Name:KHATAVKAR, SHILPA A (DDS)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:A
Last Name:KHATAVKAR
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 1:3500 MOWRY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1409
Mailing Address - Country:US
Mailing Address - Phone:510-796-1499
Mailing Address - Fax:510-796-1498
Practice Address - Street 1:3500 MOWRY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1409
Practice Address - Country:US
Practice Address - Phone:510-796-1499
Practice Address - Fax:510-796-1498
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice