Provider Demographics
NPI:1699185041
Name:THAKER, RAJ KAMLESH (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAJ
Middle Name:KAMLESH
Last Name:THAKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2332
Mailing Address - Country:US
Mailing Address - Phone:832-282-5550
Mailing Address - Fax:
Practice Address - Street 1:6155 FRY RD STE 600
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5867
Practice Address - Country:US
Practice Address - Phone:281-667-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPGY11223S0112X
390200000X
TX318461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program