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General NPI Number Information
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NPI Number | 1932543329
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Entity Type | Organization
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Legal Business Name | MAXIDENT LLC
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 825 PLAINFIELD RD
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City | JOLIET
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State | IL
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Zip | 60435-5900
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Country | US
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Telephone | 224-800-1432
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Fax |
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Provider Business Mailing Address
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Address Line | 901 S PLUM GROVE RD
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City | PALATINE
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State | IL
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Zip | 60067-7256
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Country | US
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Telephone | 224-800-1432
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SACHIN VERMA
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Credential | DDS
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Telephone | 224-800-1432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 137000782
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019028017
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License Number State | IL
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