Provider Demographics
NPI:1659893873
Name:JAIN, MAHAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHAK
Middle Name:
Last Name:JAIN
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 1:7413 STONINGTON LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-1860
Mailing Address - Country:US
Mailing Address - Phone:308-627-0901
Mailing Address - Fax:
Practice Address - Street 1:1037 W MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3356
Practice Address - Country:US
Practice Address - Phone:615-444-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN105851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty