Provider Demographics
NPI:1669635827
Name:PATHAK-MOHOLKAR, APARNA (DMD)
Entity Type:Individual
Prefix:
First Name:APARNA
Middle Name:
Last Name:PATHAK-MOHOLKAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1616
Mailing Address - Country:US
Mailing Address - Phone:978-433-6344
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEPPERELL
Practice Address - State:MA
Practice Address - Zip Code:01463
Practice Address - Country:US
Practice Address - Phone:978-433-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice