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General NPI Number Information
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NPI Number | 1427874593
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Entity Type | Organization
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Legal Business Name | SANDWICH DENTISTRY LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 1 E COUNTY LINE RD STE A
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City | SANDWICH
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State | IL
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Zip | 60548-9574
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Country | US
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Telephone | 832-766-0144
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Fax |
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Provider Business Mailing Address
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Address Line | 10735 CLOCKTOWER DR, UNIT 303 UNIT 303
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City | COUNTRYSIDE
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State | IL
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Zip | 60525
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Country | US
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Telephone | 832-766-0144
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ROHAN VIKRAM SHAH
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Credential | DDS
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Telephone | 832-766-0144
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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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