Provider Demographics
NPI:1801324843
Name:MARAHATTA, JAGADISH (DDS)
Entity type:Individual
Prefix:
First Name:JAGADISH
Middle Name:
Last Name:MARAHATTA
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 1:1014 27TH AVE SE APT B
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2757
Mailing Address - Country:US
Mailing Address - Phone:612-916-0946
Mailing Address - Fax:
Practice Address - Street 1:512 66TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1643
Practice Address - Country:US
Practice Address - Phone:763-560-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice