Provider Demographics
NPI:1144913583
Name:BHATHENA, SHENAZ ROHINTON (DMD)
Entity type:Individual
Prefix:
First Name:SHENAZ
Middle Name:ROHINTON
Last Name:BHATHENA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 FORDEM AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4637
Mailing Address - Country:US
Mailing Address - Phone:608-421-3142
Mailing Address - Fax:
Practice Address - Street 1:1602 FORDEM AVE APT 114
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4637
Practice Address - Country:US
Practice Address - Phone:608-421-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190342871223G0001X
WI6001214-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice