Provider Demographics
NPI:1891395828
Name:MAHAJAN, ROOPALI
Entity Type:Individual
Prefix:DR
First Name:ROOPALI
Middle Name:
Last Name:MAHAJAN
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 1:110 N HIGHWAY 175 STE 106
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-1843
Mailing Address - Country:US
Mailing Address - Phone:725-666-5550
Mailing Address - Fax:
Practice Address - Street 1:110 N HIGHWAY 175 STE 106
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-1843
Practice Address - Country:US
Practice Address - Phone:725-666-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX39230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program