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NPI Code Detail

MEDICARE: GENTLE DENTAL SMILE

MEDICARE: GENTLE DENTAL SMILE
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
1261QD0000XDental Clinic/CenterIL

General Provider Information

NPI Number : 1285888123
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENTLE DENTAL SMILE
Provider Business Mailing Address
First Line : 775 LARSON LN
Second Line :
City : ROSELLE
State : IL
Zip : 60172-4945
Country : US
Telephone Number : 847-361-2400
Fax Number :
Provider Business Practice Location Address
First Line : 3205 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3301
Country : US
Telephone Number : 773-267-2671
Fax Number :
Authorized Official
Title or Position : DDS
Name : DR. AMI K SHAH
Credential :
Telephone Number : 847-361-2400
Provider Enumeration Date : 11/05/2008
Last Update Date : 11/05/2008

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Directions to “GENTLE DENTAL SMILE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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