MEDICARE: DR. MEERA MAHAJAN D.D.S.,M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019-015220	IL

General Provider Information

NPI Number	:	1760724207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEERA MAHAJAN D.D.S.,M.S.

Provider Business Mailing Address
First Line	:	4711 WILLOW SPRINGS RD
Second Line	:
City	:	LA GRANGE
State	:	IL
Zip	:	60525-6143
Country	:	US
Telephone Number	:	708-354-1990
Fax Number	:	708-354-3199

Provider Business Practice Location Address
First Line	:	4711 WILLOW SPRINGS RD
Second Line	:
City	:	LA GRANGE
State	:	IL
Zip	:	60525-6143
Country	:	US
Telephone Number	:	708-354-1990
Fax Number	:	708-354-3199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	01/21/2021

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