Provider Demographics
NPI:1255062634
Name:PANJWANI, DHIRAJ
Entity type:Individual
Prefix:
First Name:DHIRAJ
Middle Name:
Last Name:PANJWANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 HITCHCOCK RD UNIT 84
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3952
Mailing Address - Country:US
Mailing Address - Phone:646-991-7174
Mailing Address - Fax:
Practice Address - Street 1:SEACOAST DENTAL ASSOCIATES
Practice Address - Street 2:170 EAST FALMOUTH HIGHWAY
Practice Address - City:EAST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536
Practice Address - Country:US
Practice Address - Phone:508-540-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN1859465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program