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NPI Code Detail

MEDICARE: CHICAGO DENTAL LLC

MEDICARE: CHICAGO DENTAL LLC
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/Center

General Provider Information

NPI Number : 1497211098
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO DENTAL LLC
Provider Business Mailing Address
First Line : 3414 W NORTH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-4807
Country : US
Telephone Number : 773-772-0077
Fax Number :
Provider Business Practice Location Address
First Line : 3414 W NORTH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-4807
Country : US
Telephone Number : 773-772-0077
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. ATUL PATEL
Credential : DDS
Telephone Number : 773-772-0077
Provider Enumeration Date : 02/19/2019
Last Update Date : 02/19/2019

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Directions to “CHICAGO DENTAL LLC ” Practice Location

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