Provider Demographics
NPI:1891714093
Name:MEHRA, PUSHKAR (DMD)
Entity Type:Individual
Prefix:
First Name:PUSHKAR
Middle Name:
Last Name:MEHRA
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 1:100 E NEWTON STREET
Mailing Address - Street 2:SUITE 407
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-4350
Mailing Address - Fax:617-638-4365
Practice Address - Street 1:100 E NEWTON STREET
Practice Address - Street 2:SUITE 407
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-4350
Practice Address - Fax:617-638-4365
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX07996OtherBCBS
MA0299944Medicaid
MA40351BMCOtherHCHP
X20055Medicare ID - Type Unspecified
MA40351BMCOtherHCHP