Provider Demographics
NPI:1700925922
Name:THAKKER, DHIRAJLAL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DHIRAJLAL
Middle Name:M
Last Name:THAKKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:E MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:631-671-9823
Mailing Address - Fax:516-794-6225
Practice Address - Street 1:772 GRAND ST
Practice Address - Street 2:BEHIND LIBERTY DRUGS
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5395
Practice Address - Country:US
Practice Address - Phone:718-218-9494
Practice Address - Fax:718-218-9494
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00558585Medicaid