Healthcare Provider Details

I. General information

NPI: 1952849697
Provider Name (Legal Business Name): KYLA DENTAL LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S PRESIDENT ST
WHEATON IL
60189-6606
US

IV. Provider business mailing address

PO BOX 779032
CHICAGO IL
60677-9032
US

V. Phone/Fax

Practice location:
  • Phone: 630-469-7696
  • Fax: 630-469-7877
Mailing address:
  • Phone: 630-469-7696
  • Fax: 630-469-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number060011845
License Number StateIL

VIII. Authorized Official

Name: DR. KAJAL JOSHI
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 630-469-7696