MEDICARE: DR. PANKAJ R. SINGHVI DMD

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
1	1223G0001X	General Practice Dentistry	DN1855685	MA

General Provider Information

NPI Number	:	1417242124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PANKAJ R. SINGHVI DMD

Provider Business Mailing Address
First Line	:	1090 NORTHCHASE PKWY SE STE 290
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-6402
Country	:	US
Telephone Number	:	678-904-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 SAINT JAMES AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-1453
Country	:	US
Telephone Number	:	413-737-5665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	06/10/2011

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