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General NPI Number Information
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NPI Number | 1063620334
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Entity Type | Individual
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Provider Name | RAJAN VERMA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 2020 E MAIN ST
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City | ST CHARLES
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State | IL
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Zip | 60174-2304
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Country | US
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Telephone | 630-513-7884
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Fax | 630-513-7849
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Provider Business Mailing Address
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Address Line | 2393 BAINBRIDGE BLVD
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City | WEST CHICAGO
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State | IL
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Zip | 60185-6423
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Country | US
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Telephone | 630-584-9088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 049649
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19-026273
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License Number State | IL
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