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General NPI Number Information
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NPI Number | 1558162289
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Entity Type | Organization
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Legal Business Name | KANDI DENTAL PC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2604 DEMPSTER ST STE 502
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City | PARK RIDGE
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State | IL
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Zip | 60068-8429
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Country | US
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Telephone | 224-217-5400
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Fax | 224-217-5405
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Provider Business Mailing Address
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Address Line | 2604 DEMPSTER ST STE 502
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City | PARK RIDGE
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State | IL
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Zip | 60068-8429
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Country | US
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Telephone | 224-217-5400
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Fax | 224-217-5405
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | KAVEH KANDI
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Credential | DDS
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Telephone | 224-217-5400
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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 |
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License Number State |
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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 |
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