Healthcare Provider Details

I. General information

NPI: 1740739135
Provider Name (Legal Business Name): PARDESI DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 DIXIE HWY
BEECHER IL
60401-3698
US

IV. Provider business mailing address

1250 S MICHIGAN AVE APT 2505
CHICAGO IL
60605-2548
US

V. Phone/Fax

Practice location:
  • Phone: 708-946-9494
  • Fax:
Mailing address:
  • Phone: 847-312-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.030152
License Number StateIL

VIII. Authorized Official

Name: MR. ZAID PARDESI
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 847-312-8721