Provider Demographics
NPI:1669600771
Name:MAHAJAN, PRITI RANA (DMD)
Entity type:Individual
Prefix:DR
First Name:PRITI
Middle Name:RANA
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 KATTMAN CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-1108
Mailing Address - Country:US
Mailing Address - Phone:317-797-6688
Mailing Address - Fax:
Practice Address - Street 1:4222 KATTMAN CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46074-1108
Practice Address - Country:US
Practice Address - Phone:317-797-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011584A1223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice