Healthcare Provider Details

I. General information

NPI: 1093361073
Provider Name (Legal Business Name): RAVI MAHESH BAROT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S ARLINGTON HEIGHTS RD STE 1
ARLINGTON HEIGHTS IL
60005-3700
US

IV. Provider business mailing address

141 W JACKSON BLVD STE 210
CHICAGO IL
60604-3048
US

V. Phone/Fax

Practice location:
  • Phone: 847-758-0100
  • Fax:
Mailing address:
  • Phone: 312-800-1270
  • Fax: 312-234-0658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.032243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: