Provider Demographics
NPI:1881434900
Name:BISHWAKARMA, LAXMAN
Entity type:Individual
Prefix:
First Name:LAXMAN
Middle Name:
Last Name:BISHWAKARMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PLEASANT ST STE 325
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5124
Mailing Address - Country:US
Mailing Address - Phone:781-397-8600
Mailing Address - Fax:
Practice Address - Street 1:6 PLEASANT ST STE 325
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5124
Practice Address - Country:US
Practice Address - Phone:240-602-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-07-10
Deactivation Date:2024-06-27
Deactivation Code:
Reactivation Date:2024-07-09
Provider Licenses
StateLicense IDTaxonomies
MADN10000330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist