Provider Demographics
NPI:1225702822
Name:MAHESH KUMAR JAIN, PRATISHTA
Entity Type:Individual
Prefix:
First Name:PRATISHTA
Middle Name:
Last Name:MAHESH KUMAR JAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 10TH ST APT 309
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1418
Mailing Address - Country:US
Mailing Address - Phone:415-530-8606
Mailing Address - Fax:
Practice Address - Street 1:180 10TH ST APT 309
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1418
Practice Address - Country:US
Practice Address - Phone:415-530-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02854200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist