Provider Demographics
NPI:1720501208
Name:VERMA, ROHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROHAN
Middle Name:
Last Name:VERMA
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 1:1130 S MICHIGAN AVE APT 802
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2317
Mailing Address - Country:US
Mailing Address - Phone:630-340-1041
Mailing Address - Fax:
Practice Address - Street 1:4501 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3758
Practice Address - Country:US
Practice Address - Phone:773-548-0600
Practice Address - Fax:773-548-0740
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist