1346647443 NPI number — SCHAUMBURG DENTAL CARE, PC/A-ONE DENTAL

Table of content: (NPI 1346647443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346647443 NPI number — SCHAUMBURG DENTAL CARE, PC/A-ONE DENTAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHAUMBURG DENTAL CARE, PC/A-ONE DENTAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346647443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2071 IRVING PARK RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
HANOVER PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60133-3159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-310-0100
Provider Business Mailing Address Fax Number:
847-220-9218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2071 IRVING PARK RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HANOVER PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60133-3159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-310-0100
Provider Business Practice Location Address Fax Number:
847-220-9218
Provider Enumeration Date:
12/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ADATIA
Authorized Official First Name:
MAYANK
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DENTIAST
Authorized Official Telephone Number:
847-769-4132

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  019017342 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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