Provider Demographics
NPI:1972098705
Name:BAJAJ, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:BAJAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E OGDEN AVE STE H
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-9501
Mailing Address - Country:US
Mailing Address - Phone:630-655-0240
Mailing Address - Fax:630-655-0253
Practice Address - Street 1:416 E OGDEN AVE STE H
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-9501
Practice Address - Country:US
Practice Address - Phone:630-655-0240
Practice Address - Fax:630-655-0253
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist