Healthcare Provider Details

I. General information

NPI: 1346355856
Provider Name (Legal Business Name): VPDENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 N NELTNOR BLVD SUITE 316
WEST CHICAGO IL
60185-5982
US

IV. Provider business mailing address

956 N NELTNOR BLVD SUITE 316
WEST CHICAGO IL
60185-5982
US

V. Phone/Fax

Practice location:
  • Phone: 630-293-7777
  • Fax: 630-293-7773
Mailing address:
  • Phone: 630-293-7777
  • Fax: 630-293-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number019026362
License Number StateIL

VIII. Authorized Official

Name: DR. AJITHA PARUCHURI
Title or Position: DENTIST
Credential: DMD
Phone: 630-293-7777