Provider Demographics
NPI:1790169779
Name:RAJ VIJ DDS INC
Entity Type:Organization
Organization Name:RAJ VIJ DDS INC
Other - Org Name:DENTISTRY 4 KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VIJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-668-9977
Mailing Address - Street 1:3523 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-5107
Mailing Address - Country:US
Mailing Address - Phone:330-668-9977
Mailing Address - Fax:
Practice Address - Street 1:3523 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-5107
Practice Address - Country:US
Practice Address - Phone:330-668-9977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19598261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0870900Medicaid