Provider Demographics
NPI:1336110501
Name:RADADIA, RITESH DHIRU (DMD)
Entity Type:Individual
Prefix:DR
First Name:RITESH
Middle Name:DHIRU
Last Name:RADADIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 GREYSTEM CIR
Mailing Address - Street 2:APT 306
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9332
Mailing Address - Country:US
Mailing Address - Phone:847-782-8953
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL GREAT LAKES
Practice Address - Street 2:BLD. 200H
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist