Provider Demographics
NPI:1013742014
Name:PJ DENTAL LLC
Entity type:Organization
Organization Name:PJ DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JITESH
Authorized Official - Middle Name:VIJAY
Authorized Official - Last Name:PIMPALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-773-5378
Mailing Address - Street 1:25 BREAKNECK HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1806
Mailing Address - Country:US
Mailing Address - Phone:734-773-5378
Mailing Address - Fax:
Practice Address - Street 1:489 BERNARDSTON RD STE 206
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1239
Practice Address - Country:US
Practice Address - Phone:734-773-5378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental