Provider Demographics
NPI:1659604346
Name:PANJINI, SHRUTI (DDS)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:PANJINI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 WASHINGTON ST STE 240
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6215
Mailing Address - Country:US
Mailing Address - Phone:781-235-6300
Mailing Address - Fax:
Practice Address - Street 1:332 WASHINGTON ST STE 240
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6215
Practice Address - Country:US
Practice Address - Phone:781-235-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13044122300000X
MA22267122300000X
MADN22267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist