Individual
PRANAV BHIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
430 MAIN ST, GREEN BAY, WI 54301-5115
(201) 492-4864
Mailing address
206 N LAFAYETTE AVE APT 4, ROYAL OAK, MI 48067-4817
(201) 492-4864
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2901022830
MI
1223P0700X
Prosthodontics
Primary
1002418-15
WI
Other
Enumeration date
09/02/2019
Last updated
08/19/2020
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