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General NPI Number Information
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NPI Number | 1487108387
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Entity Type | Individual
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Provider Name | MAHUA BOSE PILLAI DDS, MMSC
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Gender | Female
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 30 E 40TH ST RM 506
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City | NEW YORK
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State | NY
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Zip | 10016-1235
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Country | US
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Telephone | 631-681-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 200 RIVERSIDE BLVD APT 19G
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City | NEW YORK
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State | NY
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Zip | 10069-0910
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Country | US
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Telephone | 631-681-3031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN1857372
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1857372
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 060441-01
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License Number State | NY
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