Shaun Raj Varghese, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

021.002107 Issued in IL

Practice address

1225 Oak St
North Aurora, IL 60542-2006

Phone

(630) 907-9680

Fax

(630) 907-9682

NPI assigned

Mar 12, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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.

• Grand Dental Associates P.C.

  • General Practice Dentistry
  • Franklin Park, IL
  • NPI 1639203912
  NPD (past)

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592006400000",
    "number": "1639201601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 OAK ST",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605422006",
            "telephone_number": "630-907-9680",
            "fax_number": "630-907-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 OAK ST",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605422006",
            "telephone_number": "630-907-9680",
            "fax_number": "630-907-9682"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10703 Ruth Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601427156",
            "country_code": "US",
            "telephone_number": "847-961-5515",
            "fax_number": "630-907-9682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VARGHESE",
        "first_name": "SHAUN",
        "middle_name": "RAJ",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2020-06-13",
        "certification_date": "2020-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "021.002107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tutor Chiropractic Health Care, LTD.
• Brian Lee Tutor, DC
• Tuu Duc Le Inc
• Kimberly Frances Vadner, BA, CADC
• Joanna Vanlear, LCSW
• Ruby Vasquez
• Dominika Ventucci, LCSW
• Marissa Sue Vogrin, MA
• Dana Voltolina, PT
• Amaria Vondran, RBT

• Orthodontics and Dentofacial Orthopedics Dentistry in North Aurora, IL
• Providers in North Aurora, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.