Provider Demographics
NPI:1013677418
Name:THAKKAR, DAXA (DDS)
Entity Type:Individual
Prefix:
First Name:DAXA
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 SWEET CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1060
Mailing Address - Country:US
Mailing Address - Phone:780-655-0697
Mailing Address - Fax:
Practice Address - Street 1:8730 CHERRY LN STE 6
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6212
Practice Address - Country:US
Practice Address - Phone:301-433-7958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD177591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice