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General NPI Number Information
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NPI Number | 1366930604
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Entity Type | Organization
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Legal Business Name | PSP DENTAL SERVICES PC
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 5425 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2354
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Country | US
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Telephone | 708-636-0565
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Fax | 708-636-0566
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Provider Business Mailing Address
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Address Line | 5425 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2354
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Country | US
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Telephone | 708-636-0565
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Fax | 708-636-0566
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Authorized Official
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Title or Position | PRESIDENT
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Name | PARAJ PATEL
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Credential | DMD
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Telephone | 201-303-8996
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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 | IL
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