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General NPI Number Information
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NPI Number | 1417468315
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Entity Type | Individual
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Provider Name | ADIBA JAGIRDAR DMD
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Gender | Female
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 75 W NORTH AVE STE 400
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City | NORTHLAKE
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State | IL
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Zip | 60164-2314
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Country | US
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Telephone | 708-562-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 841 N YORK ST APT 302
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City | ELMHURST
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State | IL
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Zip | 60126-1249
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Country | US
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Telephone | 630-923-9043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.031290
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License Number State | IL
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