Provider Demographics
NPI:1427504828
Name:JOSHI, SHASHANK (BDS, MS)
Entity type:Individual
Prefix:DR
First Name:SHASHANK
Middle Name:
Last Name:JOSHI
Suffix:
Gender:M
Credentials:BDS, MS
Other - Prefix:DR
Other - First Name:SHASHANK
Other - Middle Name:
Other - Last Name:JOSHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:811 HOLLINS ST
Mailing Address - Street 2:APT 3
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1739 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2716
Practice Address - Country:US
Practice Address - Phone:646-464-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD111441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics