Provider Demographics
NPI:1669666913
Name:MITCHELL PASENKOFF, DMD
Entity Type:Organization
Organization Name:MITCHELL PASENKOFF, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:PASENKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-528-5351
Mailing Address - Street 1:146 MAIN ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1322
Mailing Address - Country:US
Mailing Address - Phone:508-528-5351
Mailing Address - Fax:
Practice Address - Street 1:146 MAIN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1322
Practice Address - Country:US
Practice Address - Phone:508-528-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16711261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental