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General NPI Number Information
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NPI Number | 1962913376
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Entity Type | Organization
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Legal Business Name | COSMOS FAMILY DENTAL PC
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1187 N FARNSWORTH AVE UNIT 101
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City | AURORA
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State | IL
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Zip | 60505-2270
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Country | US
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Telephone | 630-229-6503
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Fax | 630-229-6396
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Provider Business Mailing Address
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Address Line | 1187 N FARNSWORTH AVE UNIT 101
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City | AURORA
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State | IL
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Zip | 60505-2270
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Country | US
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Telephone | 630-229-6503
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Fax | 630-229-6396
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. TANIA LODHI
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Credential | DDS
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Telephone | 630-229-6503
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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 | 019-028960
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License Number State | IL
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