=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053970236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAHAJAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2019
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3501 NORTH SCOTTSDALE ROAD #142
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-949-8070
-----------------------------------------------------
Fax | 480-970-4891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3501 NORTH SCOTTSDALE ROAD #142
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-949-8070
-----------------------------------------------------
Fax | 480-970-4891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER OF MAHAJAL LLC
-----------------------------------------------------
Name | MRS. MANISHA SANGHVI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-675-2484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------