Provider Demographics
NPI:1659880318
Name:JAGAD, VAIBHAV MAHESH (DMD)
Entity type:Individual
Prefix:DR
First Name:VAIBHAV
Middle Name:MAHESH
Last Name:JAGAD
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 MIDDLESEX AVE UNIT C208
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5084
Mailing Address - Country:US
Mailing Address - Phone:815-995-2852
Mailing Address - Fax:
Practice Address - Street 1:60 EAST ST STE 2500
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4519
Practice Address - Country:US
Practice Address - Phone:978-788-9303
Practice Address - Fax:978-237-4003
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031412122300000X, 1223G0001X
MADN1857831122300000X, 1223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice