Provider Demographics
NPI:1245917012
Name:THYVELIKAKATH, MAHESH MOHAN (DDS)
Entity type:Individual
Prefix:
First Name:MAHESH
Middle Name:MOHAN
Last Name:THYVELIKAKATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MAHESH
Other - Middle Name:
Other - Last Name:MOHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7313 BLACK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-9038
Mailing Address - Country:US
Mailing Address - Phone:919-699-1010
Mailing Address - Fax:919-699-1010
Practice Address - Street 1:345 EAST 24TH STREET NEW YORK
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-998-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program