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General NPI Number Information
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NPI Number | 1174753974
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Entity Type | Organization
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Legal Business Name | PLANO FAMILY DENTAL,PC
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 901 W US HIGHWAY 34 SUITE 103
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City | PLANO
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State | IL
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Zip | 60545-2722
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Country | US
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Telephone | 630-552-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 901 W US HIGHWAY 34 SUITE 103
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City | PLANO
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State | IL
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Zip | 60545-2722
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Country | US
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Telephone | 630-552-9200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KALPANA SHAH
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Credential | D.M.D.
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Telephone | 630-552-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019025713
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License Number State | IL
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