MEDICARE: DR. USHA SHASHANK GOKHALE DDS

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	122300000X	Dentist	22DI02131200	NJ

General Provider Information

NPI Number	:	1871575829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. USHA SHASHANK GOKHALE DDS

Provider Business Mailing Address
First Line	:	3145 GARDEN AVE BLDG 1278
Second Line	:	FORT SAM HOUSTON
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-5600
Country	:	US
Telephone Number	:	210-808-3775
Fax Number	:	860-694-2590

Provider Business Practice Location Address
First Line	:	3145 GARDEN AVE BLDG 1278
Second Line	:	FORT SAM HOUSTON
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-7718
Country	:	US
Telephone Number	:	210-808-3735
Fax Number	:	860-694-2590

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	01/18/2023

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