Provider Demographics
NPI:1346598406
Name:RAJESH, MYTHILI (BDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MYTHILI
Middle Name:
Last Name:RAJESH
Suffix:
Gender:F
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 POMEROON ST
Mailing Address - Street 2:APT# 207
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4882
Mailing Address - Country:US
Mailing Address - Phone:205-356-7326
Mailing Address - Fax:
Practice Address - Street 1:3020 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1312
Practice Address - Country:US
Practice Address - Phone:773-754-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist