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General NPI Number Information
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NPI Number | 1669735767
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Entity Type | Organization
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Legal Business Name | A BRUSH WITH DENTISTRY, P.C.
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 100 N PEORIA AVE
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City | DIXON
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State | IL
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Zip | 61021-2027
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Country | US
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Telephone | 815-288-1418
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Fax | 815-288-1419
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Provider Business Mailing Address
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Address Line | 223 GRAND OAKS LN
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City | DIXON
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State | IL
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Zip | 61021-3220
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Country | US
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Telephone | 312-217-4490
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAILEE SHASHI PATEL
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Credential | D.D.S.
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Telephone | 312-217-4490
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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 | 019.027415
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License Number State | IL
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