Provider Demographics
NPI:1982958039
Name:MAHESHWARI, MUKESH
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:
Last Name:MAHESHWARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LAKEWOOD AVE
Mailing Address - Street 2:APT# 214
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3584
Mailing Address - Country:US
Mailing Address - Phone:209-204-1861
Mailing Address - Fax:
Practice Address - Street 1:2605 COFFEE RD
Practice Address - Street 2:# 200
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2064
Practice Address - Country:US
Practice Address - Phone:209-521-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-27
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice