Provider Demographics
NPI:1245689421
Name:KAUSHISH, PRANAV (DMD)
Entity type:Individual
Prefix:DR
First Name:PRANAV
Middle Name:
Last Name:KAUSHISH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 BEACON ST
Mailing Address - Street 2:APT 305
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5302
Mailing Address - Country:US
Mailing Address - Phone:678-576-3664
Mailing Address - Fax:
Practice Address - Street 1:100 EVERETT AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2309
Practice Address - Country:US
Practice Address - Phone:617-884-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18572161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice