Provider Demographics
NPI:1043767031
Name:RAGHAVAN, AARTHI (DMD)
Entity Type:Individual
Prefix:
First Name:AARTHI
Middle Name:
Last Name:RAGHAVAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:AARTHI
Other - Middle Name:VIJAY
Other - Last Name:RAGHAVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1708 BROOKDALE RD
Mailing Address - Street 2:APT 23
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2160
Mailing Address - Country:US
Mailing Address - Phone:979-324-7241
Mailing Address - Fax:
Practice Address - Street 1:2061 SYCAMORE ROAD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115
Practice Address - Country:US
Practice Address - Phone:815-900-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist