Provider Demographics
NPI:1912995333
Name:PARUCHURI, AJITHA (DMD)
Entity type:Individual
Prefix:DR
First Name:AJITHA
Middle Name:
Last Name:PARUCHURI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AJITHA
Other - Middle Name:
Other - Last Name:CHAGARLAMOODI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3080 HOPEWELL DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7035
Mailing Address - Country:US
Mailing Address - Phone:630-229-5469
Mailing Address - Fax:
Practice Address - Street 1:956 N NELTNOR BLVD
Practice Address - Street 2:SUITE-316
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-5982
Practice Address - Country:US
Practice Address - Phone:630-293-7777
Practice Address - Fax:630-293-7778
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9176632Medicaid