Healthcare Provider Details

I. General information

NPI: 1568886265
Provider Name (Legal Business Name): JNM DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2014
Last Update Date: 02/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 W ROLLINS RD
ROUND LAKE BEACH IL
60073-1350
US

IV. Provider business mailing address

23 W ROLLINS RD
ROUND LAKE BEACH IL
60073-1350
US

V. Phone/Fax

Practice location:
  • Phone: 847-740-4600
  • Fax:
Mailing address:
  • Phone: 847-740-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019029269
License Number StateIL

VIII. Authorized Official

Name: DR. SUMEDHA MOHINDRA
Title or Position: DENTIST
Credential: DDS
Phone: 630-656-7513