Provider Demographics
NPI:1588099683
Name:KATWAL, DIKSHA (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:DIKSHA
Middle Name:
Last Name:KATWAL
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MELLWOOD AVE
Mailing Address - Street 2:APT 401
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1061
Mailing Address - Country:US
Mailing Address - Phone:317-457-8381
Mailing Address - Fax:
Practice Address - Street 1:501 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1701
Practice Address - Country:US
Practice Address - Phone:502-852-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics