MEDICARE: ALORA DENTAL SPA 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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1598530107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALORA DENTAL SPA LLC

Provider Business Mailing Address
First Line	:	441 N WEBER RD
Second Line	:
City	:	ROMEOVILLE
State	:	IL
Zip	:	60446-3972
Country	:	US
Telephone Number	:	815-372-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	62B OGDEN AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2324
Country	:	US
Telephone Number	:	815-372-0100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PRADEEP KHURANA
Credential	:	DDS
Telephone Number	:	815-372-0100

Provider Enumeration Date	:	11/24/2023
Last Update Date	:	11/24/2023

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