Provider Demographics
NPI:1447716741
Name:M MAHAJAN DDS PLLC
Entity type:Organization
Organization Name:M MAHAJAN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-307-3837
Mailing Address - Street 1:4202 10TH ST SE STE 102
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2191
Mailing Address - Country:US
Mailing Address - Phone:509-307-3837
Mailing Address - Fax:
Practice Address - Street 1:4202 10TH ST SE STE 102
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2191
Practice Address - Country:US
Practice Address - Phone:509-307-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental