Provider Demographics
NPI:1679514046
Name:MAHAJAN FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:MAHAJAN FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-380-0200
Mailing Address - Street 1:23965 NOVI RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3231
Mailing Address - Country:US
Mailing Address - Phone:248-380-0200
Mailing Address - Fax:
Practice Address - Street 1:23965 NOVI RD
Practice Address - Street 2:SUITE 140
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3231
Practice Address - Country:US
Practice Address - Phone:248-380-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156711223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty