Provider Demographics
NPI:1356489405
Name:RAJ, RAJENDRA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:R
Last Name:RAJ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9343 LEM TURNER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2274
Mailing Address - Country:US
Mailing Address - Phone:904-764-3844
Mailing Address - Fax:904-765-3839
Practice Address - Street 1:9343 LEM TURNER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-2274
Practice Address - Country:US
Practice Address - Phone:904-764-3844
Practice Address - Fax:904-765-3839
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL109601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice