MEDICARE: ATLAS DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019028275	IL

General Provider Information

NPI Number	:	1104139096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS DENTAL CORP

Provider Business Mailing Address
First Line	:	7714 SOUTH CICERO AVENUE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1583
Country	:	US
Telephone Number	:	708-636-3368
Fax Number	:

Provider Business Practice Location Address
First Line	:	7714 SOUTH CICERO AVENUE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1583
Country	:	US
Telephone Number	:	708-636-3368
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUNDEEP DHAWAN
Credential	:	D.D.S.
Telephone Number	:	708-261-5208

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	12/21/2011

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Directions to “ATLAS DENTAL CORP ” Practice Location

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