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General NPI Number Information
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NPI Number | 1326927674
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Entity Type | Organization
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Legal Business Name | DENTAL SALON LLC
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Dates
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Enumeration Date | 08/30/2025
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Last Update Date | 08/30/2025
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Provider Practice Location Address
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Address Line | 939 W NORTH AVE STE 890
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City | CHICAGO
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State | IL
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Zip | 60642-8683
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Country | US
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Telephone | 312-642-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 18 MOHAWK DR
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City | SOUTH BARRINGTON
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State | IL
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Zip | 60010-9547
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | POOJA MODY
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Credential |
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Telephone | 619-885-2725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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