Provider Demographics
NPI:1518056704
Name:MAHAJAN, SHRIRANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHRIRANG
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CUNNINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-4300
Mailing Address - Country:US
Mailing Address - Phone:612-702-2035
Mailing Address - Fax:
Practice Address - Street 1:14070 COMMERCE AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1424
Practice Address - Country:US
Practice Address - Phone:952-461-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND119871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND11987OtherDELTA
MND11987OtherDENTAL LICENSE
MN193437600Medicaid
BM9002433OtherDEA