Active NPI
Shami Gokhale
- General Practice Dentistry
- Loganville, GA
National Provider Identifier
1629702899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN122835
- Practice address
- 4323 Atl Highway
Loganville, GA 30052 - Phone
- (678) 367-4615
- NPI assigned
- Jul 13, 2022
- Last updated
- Oct 17, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN122835 | GA | Primary |
Addresses
Primary practice location
4323 Atl Highway
Loganville, GA 30052
Mailing address
2210 Cedar Place CT
Snellville, GA 30078-3312
Phone (408) 669-7959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN122835 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PKR Dental LLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697500800000",
"number": "1629702899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2210 CEDAR PLACE CT",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "300783312",
"telephone_number": "408-669-7959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4323 ATL HIGHWAY",
"city": "LOGANVILLE",
"state": "GA",
"postal_code": "30052",
"telephone_number": "678-367-4615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOKHALE",
"first_name": "SHAMI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-13",
"last_updated": "2023-10-17",
"certification_date": "2023-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN122835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loganville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.