Provider Demographics
NPI:1700218393
Name:DEVISETTI, RAJESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:DEVISETTI
Suffix:
Gender:M
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:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-1731
Mailing Address - Country:US
Mailing Address - Phone:330-562-2850
Mailing Address - Fax:
Practice Address - Street 1:7455 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8760
Practice Address - Country:US
Practice Address - Phone:330-562-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0240531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice