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General NPI Number Information
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NPI Number | 1215335054
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Entity Type | Organization
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Legal Business Name | M. R. ADATIA DDS PC
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 359 N FARNSWORTH AVE
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City | AURORA
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State | IL
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Zip | 60505-3082
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Country | US
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Telephone | 630-898-0405
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Fax | 847-220-9218
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Provider Business Mailing Address
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Address Line | 1013 SHEPPEY CT
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City | NAPERVILLE
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State | IL
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Zip | 60565-6109
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Country | US
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Telephone | 847-769-4133
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHAKUNTALA M ADATIA
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Credential | DDS
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Telephone | 847-769-4132
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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 | 019017350
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License Number State | IL
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