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General NPI Number Information
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NPI Number | 1457521973
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Entity Type | Organization
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Legal Business Name | M.R.ADATIA, DDS PC
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 359 N FARNSWORTH AVE
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City | AURORA
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State | IL
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Zip | 60505-3082
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Country | US
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Telephone | 630-898-0405
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Fax | 847-220-9218
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Provider Business Mailing Address
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Address Line | 1013 SHEPPEY CT
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City | NAPERVILLE
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State | IL
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Zip | 60565-6109
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Country | US
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Telephone | 630-355-1620
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Fax | 847-220-9218
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAYANK R ADATIA
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Credential | D.D.S
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Telephone | 847-769-4132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019017350
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License Number State | IL
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Taxonomy #2
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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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