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General NPI Number Information
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NPI Number | 1447542774
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Entity Type | Organization
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Legal Business Name | DHCC.,LTD
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 5500 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60636-1107
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Country | US
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Telephone | 224-678-3511
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60636-1107
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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 | DENTIST/OWNER
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Name | DR. KISHORE GOPAL
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Credential | DMD
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Telephone | 224-678-3511
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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 | 019023845
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License Number State | IL
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