Provider Demographics
NPI:1790338473
Name:JOSHI, PRAJAKTA
Entity Type:Individual
Prefix:DR
First Name:PRAJAKTA
Middle Name:
Last Name:JOSHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NORTHAMPTON ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1873
Mailing Address - Country:US
Mailing Address - Phone:857-452-0191
Mailing Address - Fax:
Practice Address - Street 1:100 MACY ST # B2
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-4315
Practice Address - Country:US
Practice Address - Phone:978-893-3988
Practice Address - Fax:978-893-3989
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN1859613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program