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NPI Code Detail

MEDICARE: PERAL DENTAL GROUP, P.C.

MEDICARE: PERAL DENTAL GROUP, P.C.
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
11223G0001XGeneral Practice Dentistry019021835IL

General Provider Information

NPI Number : 1578737052
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERAL DENTAL GROUP, P.C.
Provider Business Mailing Address
First Line : 2722 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3920
Country : US
Telephone Number : 773-262-0500
Fax Number : 773-262-2256
Provider Business Practice Location Address
First Line : 2722 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3920
Country : US
Telephone Number : 773-262-0500
Fax Number : 773-262-2256
Authorized Official
Title or Position : DENTIST
Name : DR. VICTORIA G. VAHDANI
Credential : D.D.S.
Telephone Number : 773-262-0500
Provider Enumeration Date : 04/16/2008
Last Update Date : 04/16/2008

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