Provider Demographics
NPI:1417946872
Name:SUBBARAJU, NANDINI TUMKUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANDINI
Middle Name:TUMKUR
Last Name:SUBBARAJU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19173441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101292OtherDORAL ID #