Provider Demographics
NPI:1073289286
Name:VOHRA, REHMATBEN (DENTIST)
Entity Type:Individual
Prefix:
First Name:REHMATBEN
Middle Name:
Last Name:VOHRA
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-9777
Mailing Address - Country:US
Mailing Address - Phone:708-940-2218
Mailing Address - Fax:
Practice Address - Street 1:124 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-8906
Practice Address - Country:US
Practice Address - Phone:217-330-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033379122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist