Provider Demographics
NPI:1881825321
Name:AITHAL, CHAITRA RAO (DDS)
Entity Type:Individual
Prefix:MRS
First Name:CHAITRA
Middle Name:RAO
Last Name:AITHAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 N ACACIA DR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3712
Mailing Address - Country:US
Mailing Address - Phone:847-289-0467
Mailing Address - Fax:
Practice Address - Street 1:1301 PYOTT RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-9794
Practice Address - Country:US
Practice Address - Phone:847-458-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0280701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice