Healthcare Provider Details

I. General information

NPI: 1033938501
Provider Name (Legal Business Name): MEGHANA PRABHA DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 1/2 ALGONQUIN RD
ROLLING MEADOWS IL
60008-3608
US

IV. Provider business mailing address

1101 CREEK BEND DR
VERNON HILLS IL
60061-3307
US

V. Phone/Fax

Practice location:
  • Phone: 847-870-0888
  • Fax:
Mailing address:
  • Phone: 847-222-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGHANA V PRABHA
Title or Position: DIRECTOR
Credential: DDS
Phone: 847-222-3760