Provider Demographics
NPI:1518724319
Name:RAICHURA, JILNA (RDH, MS)
Entity Type:Individual
Prefix:
First Name:JILNA
Middle Name:
Last Name:RAICHURA
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 SKYMIST TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2824
Mailing Address - Country:US
Mailing Address - Phone:202-262-4870
Mailing Address - Fax:
Practice Address - Street 1:16815 CRABBS BRANCH WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2215
Practice Address - Country:US
Practice Address - Phone:301-963-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5358124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist