Healthcare Provider Details

I. General information

NPI: 1962169896
Provider Name (Legal Business Name): HIROSHI UENO DDS MS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HIROSHI UENO
Title or Position: OWNER
Credential: DDS MS
Phone: 314-728-7175