Healthcare Provider Details

I. General information

NPI: 1922486521
Provider Name (Legal Business Name): KAVEH N. ADEL, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 E OGDEN AVE
NAPERVILLE IL
60563-3237
US

IV. Provider business mailing address

612 E OGDEN AVE
NAPERVILLE IL
60563-3237
US

V. Phone/Fax

Practice location:
  • Phone: 630-369-8950
  • Fax: 630-369-7342
Mailing address:
  • Phone: 630-369-8950
  • Fax: 630-369-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number019024954
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019024954
License Number StateIL

VIII. Authorized Official

Name: DR. KAVEH NASIREDDIN ADEL
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 630-369-8950