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General NPI Number Information
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NPI Number | 1710922752
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Entity Type | Individual
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Provider Name | DEVANG TULSIDAS THAKKAR DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 18130 HALSTED ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-2507
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Country | US
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Telephone | 708-799-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 4271 LINDEN TREE LN
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City | GLENVIEW
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State | IL
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Zip | 60026-1224
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Country | US
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Telephone | 847-998-0207
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 21002097
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License Number State | IL
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