Provider Demographics
NPI:1457501132
Name:JHAM, RAQUEL MARTUCHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:MARTUCHI
Last Name:JHAM
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 1:148 E LAKE ST
Mailing Address - Street 2:STE C
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1182
Mailing Address - Country:US
Mailing Address - Phone:512-354-5852
Mailing Address - Fax:
Practice Address - Street 1:148 E LAKE ST
Practice Address - Street 2:STE C
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1182
Practice Address - Country:US
Practice Address - Phone:512-354-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190289191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry