Provider Demographics
NPI:1356313746
Name:PASENKOFF, MITCHELL STUART (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:STUART
Last Name:PASENKOFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MAIN ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1322
Mailing Address - Country:US
Mailing Address - Phone:508-528-5351
Mailing Address - Fax:508-541-7410
Practice Address - Street 1:146 MAIN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1322
Practice Address - Country:US
Practice Address - Phone:508-528-5351
Practice Address - Fax:508-541-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA167111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice