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General NPI Number Information
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NPI Number | 1942455795
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Entity Type | Organization
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Legal Business Name | PERIODONTAL IMPLANT SPECIALISTS
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 17W622 BUTTERFIELD RD SUITE 208
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-4037
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Country | US
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Telephone | 630-424-9404
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Fax |
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Provider Business Mailing Address
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Address Line | 17W622 BUTTERFIELD RD SUITE 208
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-4037
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Country | US
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Telephone | 630-424-9404
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Fax |
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Authorized Official
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Title or Position | OWNER/DR.
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Name | DR. AMARIK SINGH
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Credential |
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Telephone | 630-424-9404
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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 | 021001976
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License Number State | IL
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