Healthcare Provider Details

I. General information

NPI: 1679514046
Provider Name (Legal Business Name): MAHAJAN FAMILY DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23965 NOVI RD SUITE 140
NOVI MI
48375-3231
US

IV. Provider business mailing address

23965 NOVI RD SUITE 140
NOVI MI
48375-3231
US

V. Phone/Fax

Practice location:
  • Phone: 248-380-0200
  • Fax:
Mailing address:
  • Phone: 248-380-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15671
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. REKHA MAHAJAN
Title or Position: OWNER
Credential: D.D.S.
Phone: 248-380-0200