Provider Demographics
NPI:1033703350
Name:BAJWA, TANIA (DMD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:BAJWA
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 1:1200 ELM ST UNIT 514
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2521
Mailing Address - Country:US
Mailing Address - Phone:617-909-5019
Mailing Address - Fax:
Practice Address - Street 1:583 DW HWY STE D
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-3578
Practice Address - Country:US
Practice Address - Phone:603-262-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist