Provider Demographics
NPI:1518024413
Name:PRAMUKHASHISH, LLC
Entity Type:Organization
Organization Name:PRAMUKHASHISH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE-MEMBER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:PANKAJ
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-382-4104
Mailing Address - Street 1:1503 SAINT GEORGES AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3425
Mailing Address - Country:US
Mailing Address - Phone:732-382-4104
Mailing Address - Fax:732-388-6078
Practice Address - Street 1:1503 SAINT GEORGES AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3425
Practice Address - Country:US
Practice Address - Phone:732-382-4104
Practice Address - Fax:732-388-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02033900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty