MEDICARE: DR. SHASHANK JOSHI BDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	D11144	OR

General Provider Information

NPI Number	:	1427504828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHASHANK JOSHI BDS, MS

Provider Business Mailing Address
First Line	:	811 HOLLINS ST
Second Line	:	APT 3
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1739 W HARVARD AVE
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-2716
Country	:	US
Telephone Number	:	646-464-4447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	10/31/2019

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