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General NPI Number Information
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NPI Number | 1720623812
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Entity Type | Organization
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Legal Business Name | S&P DENTAL LLC
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 2319 S CICERO AVE
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City | CICERO
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State | IL
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Zip | 60804-2451
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Country | US
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Telephone | 908-265-2986
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Fax |
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Provider Business Mailing Address
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Address Line | 2319 S CICERO AVE
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City | CICERO
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State | IL
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Zip | 60804-2451
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Country | US
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Telephone | 708-477-4729
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PARTH PATEL
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Credential | D.M.D
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Telephone | 708-381-9652
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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 |
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License Number State |
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