Provider Demographics
NPI:1740291020
Name:PAHARI, GANGA S (DMD LIMITED LICENSE)
Entity type:Individual
Prefix:
First Name:GANGA
Middle Name:S
Last Name:PAHARI
Suffix:
Gender:F
Credentials:DMD LIMITED LICENSE
Other - Prefix:
Other - First Name:GANGA
Other - Middle Name:
Other - Last Name:SUBEDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:637 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3510
Mailing Address - Country:US
Mailing Address - Phone:617-825-9660
Mailing Address - Fax:617-288-7898
Practice Address - Street 1:637 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3510
Practice Address - Country:US
Practice Address - Phone:617-825-9660
Practice Address - Fax:617-288-7898
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL159211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110111167AMedicaid