MEDICARE: VALLEY VIEW DENTAL GROUP 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	122300000X	Dentist

General Provider Information

NPI Number	:	1790515922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY VIEW DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	62B OGDEN AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2324
Country	:	US
Telephone Number	:	630-923-0900
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	:	630-923-0900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRADEEP KHURANA
Credential	:
Telephone Number	:	630-923-0900

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/02/2024

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