Provider Demographics
NPI:1639201601
Name:VARGHESE, SHAUN RAJ (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:RAJ
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-2006
Mailing Address - Country:US
Mailing Address - Phone:630-907-9680
Mailing Address - Fax:630-907-9682
Practice Address - Street 1:1225 OAK ST
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-2006
Practice Address - Country:US
Practice Address - Phone:630-907-9680
Practice Address - Fax:630-907-9682
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0021071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics