Provider Demographics
NPI:1104195064
Name:PKV,INC
Entity Type:Organization
Organization Name:PKV,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUSHIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-773-1703
Mailing Address - Street 1:192 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2428
Mailing Address - Country:US
Mailing Address - Phone:207-773-1703
Mailing Address - Fax:207-773-0268
Practice Address - Street 1:192 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2428
Practice Address - Country:US
Practice Address - Phone:207-773-1703
Practice Address - Fax:207-773-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3770122300000X
ME3830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty