Praveen Kumar Gajendrareddy, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

021.002403 Issued in IL

Practice address

801 S Paulina St
M/C 621
Chicago, IL 60612-7210

Phone

(614) 657-8312

NPI assigned

Apr 15, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Best Smile Dentistry, LLC

  • Periodontics
  • Roselle, IL
  • NPI 1326316746
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1265675680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1841 MAINE DR",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600072728",
            "telephone_number": "614-657-8312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S PAULINA ST",
            "address_2": "M/C 621",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127210",
            "telephone_number": "614-657-8312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAJENDRAREDDY",
        "first_name": "PRAVEEN KUMAR",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-15",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021.002403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suman Gaire, MD
• Monserrat Gaitan
• Lashanda Gaiter, CNA
• Sujata S. Gaitonde, MD
• David Gajdosik
• Thomas Conrad Gajewicz, R.PH.
• Nancy Lynne Gajewski
• Thomas Gajewski
• Dimple Kalpesh Gajjar
• Rohan Ashwinbhai Gajjar, MD

• All providers in Chicago, IL
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.