Provider Demographics
NPI:1295619906
Name:MOHITE, TRISHNA UDAY
Entity type:Individual
Prefix:
First Name:TRISHNA
Middle Name:UDAY
Last Name:MOHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 N PURDY PKWY
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7512
Mailing Address - Country:US
Mailing Address - Phone:920-574-8415
Mailing Address - Fax:
Practice Address - Street 1:CAPTAIN JAMES A LOVELL FEDERAL HEALTH CARE CENTER
Practice Address - Street 2:3001 GREENWAY RD
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:244-610-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist