Provider Demographics
NPI:1871010165
Name:SHRIVASTAVA, MAYANK (BDS, MDS)
Entity type:Individual
Prefix:
First Name:MAYANK
Middle Name:
Last Name:SHRIVASTAVA
Suffix:
Gender:M
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 DENTAL CIRCLE
Mailing Address - Street 2:CB 7450
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7450
Mailing Address - Country:US
Mailing Address - Phone:919-537-3290
Mailing Address - Fax:919-537-3856
Practice Address - Street 1:2050 FIRST DENTAL BUILDING
Practice Address - Street 2:CB 7450
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7450
Practice Address - Country:US
Practice Address - Phone:919-537-3939
Practice Address - Fax:919-537-3856
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14049122300000X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No122300000XDental ProvidersDentist