Provider Demographics
NPI:1740279066
Name:CHIRANAND, JET (DDS)
Entity type:Individual
Prefix:DR
First Name:JET
Middle Name:
Last Name:CHIRANAND
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 1:1712 W. BELMONT AVE.
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-883-1557
Mailing Address - Fax:773-883-4994
Practice Address - Street 1:1712 W. BELMONT AVE.
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-883-1557
Practice Address - Fax:773-883-4994
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0253781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice