Provider Demographics
NPI:1316156383
Name:C G RAMMOHAN DMD PC
Entity type:Organization
Organization Name:C G RAMMOHAN DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C G
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMMOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-785-0606
Mailing Address - Street 1:11004 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628
Mailing Address - Country:US
Mailing Address - Phone:773-785-0606
Mailing Address - Fax:773-785-6167
Practice Address - Street 1:11004 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628
Practice Address - Country:US
Practice Address - Phone:773-785-0606
Practice Address - Fax:773-785-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty