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Individual

DR. REKHA MODUR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS DENTISTRY

Contact information

Practice address
1431 N WESTERN AVE STE 401, CHICAGO, IL 60622-7712
(773) 269-5540
Mailing address
1431 N WESTERN AVE STE 401, CHICAGO, IL 60622-7712
(773) 269-5540

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026099
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32088256
NM
Enumeration date
03/21/2006
Last updated
04/19/2023
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