Healthcare Provider Details

I. General information

NPI: 1053604413
Provider Name (Legal Business Name): RAHUL TANDON DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KRISHNEHA PLLC

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 02/11/2023
Certification Date: 02/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N YORK RD STE 140
HINSDALE IL
60521-8680
US

IV. Provider business mailing address

930 N YORK RD STE 140
HINSDALE IL
60521-8680
US

V. Phone/Fax

Practice location:
  • Phone: 630-655-3333
  • Fax:
Mailing address:
  • Phone: 630-655-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number021.003058
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: