Healthcare Provider Details

I. General information

NPI: 1962877332
Provider Name (Legal Business Name): SALUD DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 S. NELTNOR BLVD UNIT # G
WEST CHICAGO IL
60185
US

IV. Provider business mailing address

334 S. NELTNOR BLVD UNIT # G
WEST CHICAGO IL
60185
US

V. Phone/Fax

Practice location:
  • Phone: 224-577-5742
  • Fax:
Mailing address:
  • Phone: 224-577-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number019029817
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number019029817
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number019029817
License Number StateIL

VIII. Authorized Official

Name: HIREN PATEL
Title or Position: OWNER
Credential: DMD
Phone: 224-577-5742