Provider Demographics
NPI:1790936698
Name:MALHOTRA, MANJEEV (DDS)
Entity Type:Individual
Prefix:
First Name:MANJEEV
Middle Name:
Last Name:MALHOTRA
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 1:19558 S. HARLEM AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-6743
Mailing Address - Country:US
Mailing Address - Phone:815-469-1900
Mailing Address - Fax:815-469-1906
Practice Address - Street 1:19558 S. HARLEM AVE.
Practice Address - Street 2:SUITE 1
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-6743
Practice Address - Country:US
Practice Address - Phone:815-469-1900
Practice Address - Fax:815-469-1906
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190228001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice