Provider Demographics
NPI:1588814693
Name:RAJ DHAMRAIT D.D.S, P.C.
Entity Type:Organization
Organization Name:RAJ DHAMRAIT D.D.S, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:DHAMRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-544-3031
Mailing Address - Street 1:1001 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-2923
Mailing Address - Country:US
Mailing Address - Phone:217-544-3031
Mailing Address - Fax:217-544-9520
Practice Address - Street 1:1001 S SPRING ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-2923
Practice Address - Country:US
Practice Address - Phone:217-544-3031
Practice Address - Fax:217-544-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0218141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty