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NPI Code Detail

MEDICARE: DR. PANKAJ THAKKER DMD, MD

MEDICARE:  DR. PANKAJ  THAKKER  DMD, MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDS037336PA
21223S0112XOral and Maxillofacial Surgery (Dentist)DEN4299ME

General Provider Information

NPI Number : 1740438464
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PANKAJ THAKKER DMD, MD
Provider Business Mailing Address
First Line : 211 MOUNT AUBURN AVE
Second Line :
City : AUBURN
State : ME
Zip : 04210-8521
Country : US
Telephone Number : 207-514-7171
Fax Number : 207-514-7177
Provider Business Practice Location Address
First Line : 211 MOUNT AUBURN AVE
Second Line :
City : AUBURN
State : ME
Zip : 04210-8521
Country : US
Telephone Number : 207-514-7171
Fax Number : 207-514-7177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2008
Last Update Date : 03/20/2014

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