MEDICARE: VINAYAK DENTAL, P.C.

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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	019.027969	IL
2	122300000X	Dentist	019.027969	IL

General Provider Information

NPI Number	:	1265794747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINAYAK DENTAL, P.C.

Provider Business Mailing Address
First Line	:	5931 STEWART DR
Second Line	:	UNIT#1012
City	:	WILLOWBROOK
State	:	IL
Zip	:	60527-3158
Country	:	US
Telephone Number	:	203-362-9987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 N ROOT ST
Second Line	:	UNIT#105
City	:	AURORA
State	:	IL
Zip	:	60505-3429
Country	:	US
Telephone Number	:	203-362-9987
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/ PRESIDENT
Name	:	DR. MANISHA DESAI
Credential	:	DMD
Telephone Number	:	203-362-9987

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	11/16/2015

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