Provider Demographics
NPI:1194246835
Name:ATODARIA, MEGHRAJSINH V (DDS)
Entity type:Individual
Prefix:
First Name:MEGHRAJSINH
Middle Name:V
Last Name:ATODARIA
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 1:811 BEAUMONT DR APT 106
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-2012
Mailing Address - Country:US
Mailing Address - Phone:909-312-9957
Mailing Address - Fax:
Practice Address - Street 1:44 MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:RICHFORD
Practice Address - State:VT
Practice Address - Zip Code:05476-1141
Practice Address - Country:US
Practice Address - Phone:802-255-5581
Practice Address - Fax:802-255-5589
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031578122300000X
MEDEN45871223G0001X
VT016.0133901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice