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General NPI Number Information
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NPI Number | 1497136204
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Entity Type | Organization
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Legal Business Name | LEAD DENTAL GROUP
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 18W333 ROOSEVELT RD STE C
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City | LOMBARD
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State | IL
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Zip | 60148-4180
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Country | US
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Telephone | 630-832-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 18W333 ROOSEVELT ROAD SUITE C
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-832-1500
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. SHILPA MAILAPUR
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Credential | DMD, MSD
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Telephone | 630-270-8327
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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 | 021002344
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License Number State | IL
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