Provider Demographics
NPI:1407257553
Name:717DENTIST
Entity Type:Organization
Organization Name:717DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJITHIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-393-7515
Mailing Address - Street 1:1337 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4632
Mailing Address - Country:US
Mailing Address - Phone:717-393-7515
Mailing Address - Fax:717-393-7548
Practice Address - Street 1:1337 ELM AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4632
Practice Address - Country:US
Practice Address - Phone:717-393-7515
Practice Address - Fax:717-393-7548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty