Provider Demographics
NPI:1861235434
Name:MAHAJAN, PALACK (DMD)
Entity type:Individual
Prefix:DR
First Name:PALACK
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 1:179 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1829
Mailing Address - Country:US
Mailing Address - Phone:847-533-3422
Mailing Address - Fax:
Practice Address - Street 1:9744 N IL ROUTE 47
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9323
Practice Address - Country:US
Practice Address - Phone:847-669-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019035215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist