Provider Demographics
NPI:1750647335
Name:THAKRAR, SAMEET
Entity Type:Individual
Prefix:MR
First Name:SAMEET
Middle Name:
Last Name:THAKRAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WESTBROOK CORPORATE CTR STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5785
Mailing Address - Country:US
Mailing Address - Phone:708-562-5621
Mailing Address - Fax:708-562-7657
Practice Address - Street 1:4 WESTBROOK CORPORATE CTR STE 102
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5785
Practice Address - Country:US
Practice Address - Phone:708-562-5621
Practice Address - Fax:708-562-7657
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0290941223G0001X
IL190290941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice