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NPI Code Detail

MEDICARE: AVIGYA SHRESTHA DMD

MEDICARE: AVIGYA SHRESTHA DMD
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
11223G0001XGeneral Practice Dentistry1001912-15WI

General Provider Information

NPI Number : 1245719087
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVIGYA SHRESTHA DMD
Provider Business Mailing Address
First Line : 542 S MIDVALE BLVD
Second Line :
City : MADISON
State : WI
Zip : 53711-1423
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1714 N RANDALL AVE
Second Line :
City : JANESVILLE
State : WI
Zip : 53545-0900
Country : US
Telephone Number : 608-756-1229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2018
Last Update Date : 08/13/2018

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Directions to “ AVIGYA SHRESTHA DMD” Practice Location

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