Healthcare Provider Details

I. General information

NPI: 1144146374
Provider Name (Legal Business Name): GOPI VAGHANI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W LAKE ST
ADDISON IL
60101-2307
US

IV. Provider business mailing address

516 W LAKE ST
ADDISON IL
60101-2307
US

V. Phone/Fax

Practice location:
  • Phone: 630-278-4272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019037099
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: