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General NPI Number Information
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NPI Number | 1982958039
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Entity Type | Individual
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Provider Name | MUKESH MAHESHWARI
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Gender | Male
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Dates
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Enumeration Date | 10/27/2012
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 2605 COFFEE RD # 200
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City | MODESTO
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State | CA
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Zip | 95355-2064
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Country | US
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Telephone | 209-521-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 LAKEWOOD AVE APT# 214
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City | MODESTO
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State | CA
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Zip | 95355-3584
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Country | US
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Telephone | 209-204-1861
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61997
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License Number State | CA
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