Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019.028773 | IL |
Y | 1223X0400X | Orthodontists | 021.002444 | IL |
NPI | 1053690255 |
---|---|
Provider Name | Dr. Ashwini S Joshi |
First Address | Wheeling, IL 60090-6715 |
Second Address | Chicago, IL 60647-5216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2011 |
Last Update Date | 14/02/2013 |