Provider Demographics
NPI:1871161653
Name:MOPIDEVI, JIGEESHA (DDS)
Entity type:Individual
Prefix:
First Name:JIGEESHA
Middle Name:
Last Name:MOPIDEVI
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 1:405 BISHOPS WAY UNIT 438
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6255
Mailing Address - Country:US
Mailing Address - Phone:510-579-6264
Mailing Address - Fax:
Practice Address - Street 1:N14W23833 STONE RIDGE DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1157
Practice Address - Country:US
Practice Address - Phone:262-357-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10025731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice