Provider Demographics
NPI:1194370403
Name:PRADHAN, RAJAS MILIND (DDS)
Entity type:Individual
Prefix:DR
First Name:RAJAS
Middle Name:MILIND
Last Name:PRADHAN
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 1:4931 N 42ND WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2750
Mailing Address - Country:US
Mailing Address - Phone:225-439-8438
Mailing Address - Fax:
Practice Address - Street 1:13828 W GREENWAY RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5293
Practice Address - Country:US
Practice Address - Phone:623-562-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist