Provider Demographics
NPI:1437584570
Name:JOSHI, REKHA (DDS)
Entity type:Individual
Prefix:
First Name:REKHA
Middle Name:
Last Name:JOSHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HOCKANUM BLVD UNIT 5106
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-7012
Mailing Address - Country:US
Mailing Address - Phone:480-259-2764
Mailing Address - Fax:
Practice Address - Street 1:ADVANCE DENTAL PC
Practice Address - Street 2:1795 MAIN STREET SUITE 203
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103
Practice Address - Country:US
Practice Address - Phone:413-733-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18576891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1598759292Medicaid