MEDICARE: DR. KRISHNA ANIL GHEEWALA DDS

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
1	122300000X	Dentist	7704	OK

General Provider Information

NPI Number	:	1669164364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISHNA ANIL GHEEWALA DDS

Provider Business Mailing Address
First Line	:	3440 LAKESIDE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73160-2725
Country	:	US
Telephone Number	:	580-743-1003
Fax Number	:

Provider Business Practice Location Address
First Line	:	8811 E RENO AVE STE 103
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7726
Country	:	US
Telephone Number	:	405-732-2660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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