Provider Demographics
NPI:1184023772
Name:THAKUR, PREETANJALI (BDS)
Entity Type:Individual
Prefix:
First Name:PREETANJALI
Middle Name:
Last Name:THAKUR
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVENUE WEST SUITE 189S
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114
Mailing Address - Country:US
Mailing Address - Phone:651-332-7474
Mailing Address - Fax:651-332-7475
Practice Address - Street 1:2550 UNIVERSITY AVENUE WEST SUITE 189S
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:651-332-7474
Practice Address - Fax:651-332-7475
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS127122300000X, 1223S0112X
MNR607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist