Provider Demographics
NPI:1104519941
Name:RAJPUT, GURLEEN (DDS)
Entity type:Individual
Prefix:
First Name:GURLEEN
Middle Name:
Last Name:RAJPUT
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 1:615 E 162ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2329
Mailing Address - Country:US
Mailing Address - Phone:708-331-1900
Mailing Address - Fax:
Practice Address - Street 1:41 E 8TH ST APT 3202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2441
Practice Address - Country:US
Practice Address - Phone:414-426-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist