Healthcare Provider Details

I. General information

NPI: 1164807632
Provider Name (Legal Business Name): HIROSHI UENO D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 ELK GROVE TOWN CTR
ELK GROVE VILLAGE IL
60007-3754
US

IV. Provider business mailing address

820 SARA CT
ELK GROVE VILLAGE IL
60007-2900
US

V. Phone/Fax

Practice location:
  • Phone: 224-722-6222
  • Fax:
Mailing address:
  • Phone: 314-728-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number019030229
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021002701
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: