Individual
PRAVEEN KUMAR GAJENDRAREDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
801 S PAULINA ST, M/C 621, CHICAGO, IL 60612-7210
(614) 657-8312
Mailing address
1841 MAINE DR, ELK GROVE VILLAGE, IL 60007-2728
(614) 657-8312
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
021.002403
IL
Other
Enumeration date
04/15/2009
Last updated
12/13/2011
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