Provider Demographics
NPI:1417028226
Name:RAINA, MANDEEP
Entity type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:
Last Name:RAINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 NAPERVILLE RD.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-381-4021
Mailing Address - Fax:
Practice Address - Street 1:2323 NAPERVILLE RD.
Practice Address - Street 2:SUITE 110
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-381-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0262081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice