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General NPI Number Information
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NPI Number | 1972335859
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Entity Type | Organization
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Legal Business Name | PINKY PROMISE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 1355 E OGDEN AVE STE 105
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City | NAPERVILLE
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State | IL
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Zip | 60563-1631
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Country | US
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Telephone | 630-687-9292
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 E OGDEN AVE STE 105
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City | NAPERVILLE
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State | IL
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Zip | 60563-1631
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Country | US
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Telephone | 630-687-9292
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | NEELON CHIRAG PATEL
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Credential |
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Telephone | 630-687-9292
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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 |
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License Number State |
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