Healthcare Provider Details

I. General information

NPI: 1902587991
Provider Name (Legal Business Name): ROOPALI MITTAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N BOLINGBROOK DR
BOLINGBROOK IL
60440-1957
US

IV. Provider business mailing address

3347 TIMBER CREEK LN
NAPERVILLE IL
60565-3534
US

V. Phone/Fax

Practice location:
  • Phone: 312-999-9993
  • Fax:
Mailing address:
  • Phone: 630-414-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.034577
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number28477
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12014557A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: