Healthcare Provider Details

I. General information

NPI: 1467356089
Provider Name (Legal Business Name): MS. ARDITA AJDINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 MANSION RD STE D
SPRINGFIELD IL
62711-6811
US

IV. Provider business mailing address

2000 GRANTS POND
CHATHAM IL
62629-4409
US

V. Phone/Fax

Practice location:
  • Phone: 217-269-1534
  • Fax:
Mailing address:
  • Phone: 217-652-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019037495
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: