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General NPI Number Information
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NPI Number | 1669164364
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Entity Type | Individual
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Provider Name | KRISHNA ANIL GHEEWALA DDS
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Gender | Male
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 8811 E RENO AVE STE 103
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City | MIDWEST CITY
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State | OK
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Zip | 73110-7726
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Country | US
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Telephone | 405-732-2660
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Fax |
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Provider Business Mailing Address
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Address Line | 3440 LAKESIDE DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73160-2725
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Country | US
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Telephone | 580-743-1003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7704
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License Number State | OK
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