Provider Demographics
NPI:1982763298
Name:RAMMOHAN, CHENNAPUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHENNAPUR
Middle Name:
Last Name:RAMMOHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:C.G
Other - Middle Name:
Other - Last Name:RAMMOHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:11004 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-3909
Mailing Address - Country:US
Mailing Address - Phone:773-785-0606
Mailing Address - Fax:773-785-6167
Practice Address - Street 1:11004 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3909
Practice Address - Country:US
Practice Address - Phone:773-785-0606
Practice Address - Fax:773-785-6167
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist