Provider Demographics
NPI:1700561032
Name:TAKHAR, RAJBIR
Entity Type:Individual
Prefix:
First Name:RAJBIR
Middle Name:
Last Name:TAKHAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 ZAIN CIR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2831
Mailing Address - Country:US
Mailing Address - Phone:760-214-8976
Mailing Address - Fax:
Practice Address - Street 1:270 NEW STATE HWY STE 9A
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-5459
Practice Address - Country:US
Practice Address - Phone:508-822-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18598881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program