Provider Demographics
NPI:1265145064
Name:MAHAVIR DENTAL LLC
Entity type:Organization
Organization Name:MAHAVIR DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHRENIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-246-2842
Mailing Address - Street 1:3194 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3386
Mailing Address - Country:US
Mailing Address - Phone:470-649-3970
Mailing Address - Fax:470-649-3971
Practice Address - Street 1:3194 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3386
Practice Address - Country:US
Practice Address - Phone:470-649-3970
Practice Address - Fax:470-649-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty