Provider Demographics
NPI:1427214204
Name:MAHAJAN, MONIKA (DDS)
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 10TH ST SE # 102
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2191
Mailing Address - Country:US
Mailing Address - Phone:253-446-2751
Mailing Address - Fax:
Practice Address - Street 1:4202 10TH ST SE STE 102
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2191
Practice Address - Country:US
Practice Address - Phone:253-446-2751
Practice Address - Fax:253-446-6053
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60019075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL670989339OtherUIN NUMBER