Basic Information
| Provider Information | |||||||||
| NPI: | 1295387983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GHOLEKAR | ||||||||
| FirstName: | AGNISH | ||||||||
| MiddleName: | MAHESH | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1912 HAYES AVE STE D | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448704736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195022800 | ||||||||
| FaxNumber: | 4195022821 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 BENEDICT AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448572346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195022800 | ||||||||
| FaxNumber: | 4195022821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2019 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 30.026675 | OH | Y | Dental Providers | Dentist | General Practice |
No ID Information.