Provider Demographics
NPI:1235810557
Name:CHAUDHARI, PUJA VIJAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:PUJA
Middle Name:VIJAY
Last Name:CHAUDHARI
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 1:530 W BARRY AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5408
Mailing Address - Country:US
Mailing Address - Phone:423-933-4995
Mailing Address - Fax:
Practice Address - Street 1:530 W BARRY AVE APT 3F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5408
Practice Address - Country:US
Practice Address - Phone:423-933-4995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist