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General NPI Number Information
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NPI Number | 1609136373
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Entity Type | Organization
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Legal Business Name | SCM DENTAL PC
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 2435 GLENWOOD AVE
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City | JOLIET
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State | IL
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Zip | 60435-5461
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Country | US
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Telephone | 815-725-0260
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Fax | 815-729-2126
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Provider Business Mailing Address
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Address Line | 2400 GLENWOOD AVE SUITE 225
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City | JOLIET
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State | IL
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Zip | 60435-5474
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Country | US
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Telephone | 815-725-0260
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Fax | 815-729-2126
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SONAL C MEHTA
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Credential | DDS
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Telephone | 815-725-0260
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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 | 019027726
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License Number State | IL
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