Provider Demographics
NPI:1275706095
Name:NANDINI SUBBARAJU
Entity Type:Organization
Organization Name:NANDINI SUBBARAJU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANDINI
Authorized Official - Middle Name:T
Authorized Official - Last Name:SUBBARAJU
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-376-2777
Mailing Address - Street 1:1950 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4204
Mailing Address - Country:US
Mailing Address - Phone:773-376-2777
Mailing Address - Fax:773-376-2736
Practice Address - Street 1:1950 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4204
Practice Address - Country:US
Practice Address - Phone:773-376-2777
Practice Address - Fax:773-376-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1917344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty