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NPI Code Detail

MEDICARE: MEDA DENTAL II LLC

MEDICARE: MEDA DENTAL II LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1215548771
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDA DENTAL II LLC
Provider Business Mailing Address
First Line : 2735 HASSERT BLVD STE 159
Second Line :
City : NAPERVILLE
State : IL
Zip : 60564-5205
Country : US
Telephone Number : 630-352-4141
Fax Number : 630-352-4430
Provider Business Practice Location Address
First Line : 2735 HASSERT BLVD STE 159
Second Line :
City : NAPERVILLE
State : IL
Zip : 60564-5205
Country : US
Telephone Number : 630-352-4141
Fax Number : 630-352-4430
Authorized Official
Title or Position : OWNER
Name : SATHYA MEDA NAGA
Credential : DDS
Telephone Number : 630-329-2525
Provider Enumeration Date : 08/10/2020
Last Update Date : 08/10/2020

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Directions to “MEDA DENTAL II LLC ” Practice Location

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