Provider Demographics
NPI:1356638126
Name:UTREJA, ACHINT (BDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:ACHINT
Middle Name:
Last Name:UTREJA
Suffix:
Gender:M
Credentials:BDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 COLLEGE AVE
Mailing Address - Street 2:BLDG 286
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4700
Mailing Address - Country:US
Mailing Address - Phone:618-474-7215
Mailing Address - Fax:
Practice Address - Street 1:2800 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-474-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012448A1223X0400X
390200000X
IL0190304561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program