Provider Demographics
NPI:1497033427
Name:JADHAV, RAHUL (DDS)
Entity type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:JADHAV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 S ARCHER AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-1116
Mailing Address - Country:US
Mailing Address - Phone:417-693-3035
Mailing Address - Fax:773-787-2400
Practice Address - Street 1:17W704 BUTTERFIELD RD
Practice Address - Street 2:APT 205, VERSAILLES ON THE LAKE
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4356
Practice Address - Country:US
Practice Address - Phone:417-693-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019.0287761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program