=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770378721
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENISHA SHRESTHA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2025
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 FALL RIVER AVE
-----------------------------------------------------
City | SEEKONK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02771-5929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-948-0872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 EAST ST APT B306
-----------------------------------------------------
City | NORTH ATTLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02760-2547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-585-4099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DEN03821
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN10001125
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------