Healthcare Provider Details

I. General information

NPI: 1326979246
Provider Name (Legal Business Name): GAURAV SURESH TANEJA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 STERNBERG DR
HAYS KS
67601-2060
US

IV. Provider business mailing address

791 SIGMUND RD
NAPERVILLE IL
60563-1391
US

V. Phone/Fax

Practice location:
  • Phone: 785-992-0345
  • Fax:
Mailing address:
  • Phone: 630-923-3094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62337
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: