Provider Demographics
NPI:1578619607
Name:MALHOTRA, RITU (DDS)
Entity Type:Individual
Prefix:DR
First Name:RITU
Middle Name:
Last Name:MALHOTRA
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 1:1153 CHESTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3799
Mailing Address - Country:US
Mailing Address - Phone:847-689-3800
Mailing Address - Fax:
Practice Address - Street 1:2127 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-2801
Practice Address - Country:US
Practice Address - Phone:847-689-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice