Provider Demographics
NPI:1063180321
Name:DWADASI, BHARGAVI (DDS)
Entity type:Individual
Prefix:
First Name:BHARGAVI
Middle Name:
Last Name:DWADASI
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 1:2145 W GREENBRIAR CT APT 2A
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8156
Mailing Address - Country:US
Mailing Address - Phone:425-598-6300
Mailing Address - Fax:
Practice Address - Street 1:821 S LAYTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1225
Practice Address - Country:US
Practice Address - Phone:414-645-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002697-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice