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General NPI Number Information
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NPI Number | 1639511017
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Entity Type | Individual
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Provider Name | SANJEEV GOPE DDS
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Gender | Male
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 75 W NORTH AVE
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City | NORTHLAKE
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State | IL
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Zip | 60164-2306
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Country | US
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Telephone | 708-562-5100
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Fax | 708-562-5112
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Provider Business Mailing Address
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Address Line | 850 FOXWORTH BLVD APT # 210
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City | LOMBARD
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State | IL
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Zip | 60148-7035
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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 |
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Name |
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Credential |
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Telephone |
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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 | 019029561
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License Number State | IL
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