Provider Demographics
NPI:1760724207
Name:MAHAJAN, MEERA (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:MEERA
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:F
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 1:4711 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6143
Mailing Address - Country:US
Mailing Address - Phone:708-354-1990
Mailing Address - Fax:708-354-3199
Practice Address - Street 1:4711 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6143
Practice Address - Country:US
Practice Address - Phone:708-354-1990
Practice Address - Fax:708-354-3199
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-015220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist