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NPI Code Detail

MEDICARE: DR. CHENNAPUR RAMMOHAN DMD

MEDICARE: DR. CHENNAPUR RAMMOHAN DMD
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
1122300000XDentistIL

General Provider Information

NPI Number : 1982763298
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHENNAPUR RAMMOHAN DMD
Provider Business Mailing Address
First Line : 11004 S HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-3909
Country : US
Telephone Number : 773-785-0606
Fax Number : 773-785-6167
Provider Business Practice Location Address
First Line : 11004 S HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-3909
Country : US
Telephone Number : 773-785-0606
Fax Number : 773-785-6167
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 07/08/2007

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Directions to “ DR. CHENNAPUR RAMMOHAN DMD” Practice Location

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