Provider Demographics
NPI:1982045779
Name:DHANANI, RAJESH
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:DHANANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8337 SUMMER PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1991
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:419 OLD ELKHART RD
Practice Address - Street 2:STE 110
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5922
Practice Address - Country:US
Practice Address - Phone:903-723-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice