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General NPI Number Information
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NPI Number | 1952849697
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Entity Type | Organization
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Legal Business Name | KYLA DENTAL LTD
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 722 S PRESIDENT ST
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City | WHEATON
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State | IL
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Zip | 60189-6606
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Country | US
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Telephone | 630-469-7696
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Fax | 630-469-7877
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Provider Business Mailing Address
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Address Line | PO BOX 779032
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City | CHICAGO
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State | IL
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Zip | 60677-9032
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Country | US
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Telephone | 630-469-7696
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Fax | 630-469-7877
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. KAJAL JOSHI
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Credential | DMD
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Telephone | 630-469-7696
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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 | 060011845
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License Number State | IL
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