Healthcare Provider Details

I. General information

NPI: 1396258000
Provider Name (Legal Business Name): APEX DENTAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 W PETERSON AVE UPPR LEVEL
CHICAGO IL
60659-3505
US

IV. Provider business mailing address

4939 N KIMBALL AVE APT 2
CHICAGO IL
60625-5110
US

V. Phone/Fax

Practice location:
  • Phone: 773-267-1110
  • Fax: 773-267-1110
Mailing address:
  • Phone: 908-265-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number019.031286
License Number StateIL

VIII. Authorized Official

Name: DR. SUHEL DUKANWALA
Title or Position: OWNER
Credential: DENTIST
Phone: 908-265-2986