Healthcare Provider Details

I. General information

NPI: 1295353696
Provider Name (Legal Business Name): DHIREN KSHATRI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2020
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6888 GOODMAN RD STE 123
OLIVE BRANCH MS
38654-8761
US

IV. Provider business mailing address

6765 ALDWYCH DR
GERMANTOWN TN
38138-0633
US

V. Phone/Fax

Practice location:
  • Phone: 662-782-5274
  • Fax:
Mailing address:
  • Phone: 423-322-6938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11344
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number418021
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: