Provider Demographics
NPI:1871575829
Name:GOKHALE, USHA SHASHANK (DDS)
Entity type:Individual
Prefix:DR
First Name:USHA
Middle Name:SHASHANK
Last Name:GOKHALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3145 GARDEN AVE BLDG 1278
Mailing Address - Street 2:FORT SAM HOUSTON
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-5600
Mailing Address - Country:US
Mailing Address - Phone:210-808-3775
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:3145 GARDEN AVE BLDG 1278
Practice Address - Street 2:FORT SAM HOUSTON
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-7718
Practice Address - Country:US
Practice Address - Phone:210-808-3735
Practice Address - Fax:860-694-2590
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02131200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN