Provider Demographics
NPI:1295085215
Name:MOHINDRA, SUMEDHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SUMEDHA
Middle Name:
Last Name:MOHINDRA
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 1:901 S ASHLAND AVE
Mailing Address - Street 2:# 811 A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4001
Mailing Address - Country:US
Mailing Address - Phone:630-656-7513
Mailing Address - Fax:
Practice Address - Street 1:901 S ASHLAND AVE
Practice Address - Street 2:# 811 A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4001
Practice Address - Country:US
Practice Address - Phone:630-656-7513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190292691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice