Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS042624 | PA |
NPI | 1073002697 |
---|---|
Provider Name | Khushali Ghetia |
First Address | New Haven, CT 06510-3220 |
Second Address | Philadelphia, PA 19115-1008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2018 |
Last Update Date | 20/05/2020 |