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General NPI Number Information
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NPI Number | 1568099430
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Entity Type | Organization
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Legal Business Name | M SADRAMELI DMD LLC
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 3020 REFLECTION DR STE 112
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City | NAPERVILLE
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State | IL
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Zip | 60564-9701
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Country | US
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Telephone | 639-718-1901
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S PRAIRIE AVE APT 4805
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City | CHICAGO
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State | IL
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Zip | 60605-3570
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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 | PRESIDENT/OWNER
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Name | DR. MAHTAB SADRAMELI
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Credential | DMD
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Telephone | 415-336-0767
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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 |
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License Number State |
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