Healthcare Provider Details

I. General information

NPI: 1194358960
Provider Name (Legal Business Name): ESHA DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 W LAKE ST
ADDISON IL
60101-1870
US

IV. Provider business mailing address

414 WOODSIDE DR
WOOD DALE IL
60191-2535
US

V. Phone/Fax

Practice location:
  • Phone: 630-660-8929
  • Fax:
Mailing address:
  • Phone: 630-660-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNITA SAHU
Title or Position: PARTNER
Credential:
Phone: 630-660-8929