Healthcare Provider Details

I. General information

NPI: 1942689062
Provider Name (Legal Business Name): ELITE DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 OGDEN AVE SUITE 104
AURORA IL
60504-7514
US

IV. Provider business mailing address

2124 OGDEN AVE SUITE 104
AURORA IL
60504-7514
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-6100
  • Fax: 630-585-6107
Mailing address:
  • Phone: 630-585-6100
  • Fax: 630-585-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number019027694
License Number StatePA

VIII. Authorized Official

Name: DR. ANEEL BELANI
Title or Position: OWNER OF PRACTICE
Credential: DDS
Phone: 630-585-6100