Provider Demographics
NPI:1801648944
Name:MAHENDRASAH, AJAY P (DMD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:P
Last Name:MAHENDRASAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 ALPINIA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34288-8594
Mailing Address - Country:US
Mailing Address - Phone:941-979-2445
Mailing Address - Fax:
Practice Address - Street 1:1328 ALPINIA RD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-8594
Practice Address - Country:US
Practice Address - Phone:941-979-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program