Provider Demographics
NPI:1992930887
Name:NAGPAL, RUCHI
Entity type:Individual
Prefix:
First Name:RUCHI
Middle Name:
Last Name:NAGPAL
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 1:555 W KINZIE ST APT 1405
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5845
Mailing Address - Country:US
Mailing Address - Phone:440-821-8990
Mailing Address - Fax:
Practice Address - Street 1:281 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2718
Practice Address - Country:US
Practice Address - Phone:847-446-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028451122300000X
NY167472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist