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General NPI Number Information
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NPI Number | 1871808311
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Entity Type | Organization
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Legal Business Name | BANSRI SHROFF, DMD PC
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 899 S WEBER RD SUITE B
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City | BOLINGBROOK
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State | IL
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Zip | 60490-5488
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Country | US
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Telephone | 630-226-1100
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Fax | 630-863-7499
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Provider Business Mailing Address
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Address Line | 899 S WEBER RD SUITE B
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City | BOLINGBROOK
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State | IL
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Zip | 60490-5488
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Country | US
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Telephone | 630-226-1100
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Fax | 630-863-7499
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | BANSRI SHROFF
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Credential | DMD
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Telephone | 630-226-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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