Provider Demographics
NPI:1023252939
Name:KSHATRI, RAJAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:
Last Name:KSHATRI
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 1:231 W OLD HICKORY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-3664
Mailing Address - Country:US
Mailing Address - Phone:615-865-5750
Mailing Address - Fax:615-868-8638
Practice Address - Street 1:231 W OLD HICKORY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-3664
Practice Address - Country:US
Practice Address - Phone:615-865-5750
Practice Address - Fax:615-868-8638
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN89711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513465Medicaid