Provider Demographics
NPI:1356084784
Name:CANCHI DHANRAJ, DHAWALRAJ (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:DHAWALRAJ
Middle Name:
Last Name:CANCHI DHANRAJ
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 TALL OAKS CT APT 24
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4114
Mailing Address - Country:US
Mailing Address - Phone:347-744-0755
Mailing Address - Fax:
Practice Address - Street 1:2158 INTELLIPLEX DR STE 114
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8549
Practice Address - Country:US
Practice Address - Phone:317-392-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0276531223G0001X
OHRES.0044381223G0001X
IN12014568A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice