Individual
MIRAJ KISHOR SANGHVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS,MD
Contact information
Practice address
756 PORTER AVE, SUITE 400, STOCKTON, CA 95207-4232
(209) 951-6387
Mailing address
756 PORTER AVE, SUITE 400, STOCKTON, CA 95207-4232
(209) 951-6387
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
53943
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
A115872
CA
Other
Enumeration date
07/02/2008
Last updated
10/20/2011
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