Provider Demographics
NPI:1710267794
Name:PAHWA, MAYANK (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAYANK
Middle Name:
Last Name:PAHWA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 LYNNFIELD ST
Mailing Address - Street 2:PERFECT DENTAL
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5201
Mailing Address - Country:US
Mailing Address - Phone:978-587-3368
Mailing Address - Fax:978-587-6921
Practice Address - Street 1:79 LYNNFIELD ST
Practice Address - Street 2:PERFECT DENTAL
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5201
Practice Address - Country:US
Practice Address - Phone:978-587-3368
Practice Address - Fax:978-587-6921
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29309122300000X
MADN1855844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist