MEDICARE: S&P 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1720623812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S&P DENTAL LLC

Provider Business Mailing Address
First Line	:	2319 S CICERO AVE
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2451
Country	:	US
Telephone Number	:	708-477-4729
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 S CICERO AVE
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2451
Country	:	US
Telephone Number	:	908-265-2986
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PARTH PATEL
Credential	:	D.M.D
Telephone Number	:	708-381-9652

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	05/09/2022

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Directions to “S&P DENTAL LLC ” Practice Location

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