Healthcare Provider Details

I. General information

NPI: 1700711041
Provider Name (Legal Business Name): SIDDHI VINAYAK BENSENVILLE DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 IRVING PARK RD
BENSENVILLE IL
60106
US

IV. Provider business mailing address

6549 GARFIELD AVE
BURR RIDGE IL
60527-5238
US

V. Phone/Fax

Practice location:
  • Phone: 203-895-3594
  • Fax:
Mailing address:
  • Phone: 203-895-3594
  • Fax: 630-800-1672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANISHA DESAI
Title or Position: PARTNER/DENTIST
Credential: DMD
Phone: 203-895-3594