Provider Demographics
NPI:1225264179
Name:RAJAN SHARMA, DDS, MSD, PC
Entity Type:Organization
Organization Name:RAJAN SHARMA, DDS, MSD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-667-3636
Mailing Address - Street 1:1424 E 53RD ST
Mailing Address - Street 2:#209
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4500
Mailing Address - Country:US
Mailing Address - Phone:773-667-3636
Mailing Address - Fax:
Practice Address - Street 1:1424 E 53RD ST
Practice Address - Street 2:#209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4500
Practice Address - Country:US
Practice Address - Phone:773-667-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0015691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty