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General NPI Number Information
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NPI Number | 1871942730
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Entity Type | Organization
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Legal Business Name | HUB FAMILY DENTAL
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 409 LINCOLN HIGHWAY
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City | ROCHELLE
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State | IL
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Zip | 61068
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Country | US
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Telephone | 815-561-6058
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Fax |
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Provider Business Mailing Address
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Address Line | 409 LINCOLN HWY
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City | ROCHELLE
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State | IL
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Zip | 61068-1642
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Country | US
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Telephone | 815-561-6058
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Fax | 815-524-2567
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. SHAZEEN M PARDESI
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Credential | DDS
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Telephone | 815-262-4540
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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 | 019030152
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License Number State | IL
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