Provider Demographics
NPI:1538288410
Name:MOHAN, SHALINI (DMD)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60C S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8594
Mailing Address - Country:US
Mailing Address - Phone:630-554-7725
Mailing Address - Fax:630-554-7726
Practice Address - Street 1:60C S MAIN ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8594
Practice Address - Country:US
Practice Address - Phone:630-554-7725
Practice Address - Fax:630-554-7726
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist