Provider Demographics
NPI:1104563816
Name:MAHAJAN, NIDHI (DMD)
Entity type:Individual
Prefix:DR
First Name:NIDHI
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WARREN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3012
Mailing Address - Country:US
Mailing Address - Phone:920-887-1432
Mailing Address - Fax:
Practice Address - Street 1:105 WARREN ST STE 2
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3012
Practice Address - Country:US
Practice Address - Phone:262-524-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-14
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001011-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist