MEDICARE: MORTON GROVE DENTISTRY LTD

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	261QD0000X	Dental Clinic/Center	19023567	IL

General Provider Information

NPI Number	:	1265978423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORTON GROVE DENTISTRY LTD

Provider Business Mailing Address
First Line	:	7140 DEMPSTER ST
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2053
Country	:	US
Telephone Number	:	847-967-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	7140 DEMPSTER ST
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2053
Country	:	US
Telephone Number	:	847-967-8999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. RASHMIKA B PATEL
Credential	:	D.D.S
Telephone Number	:	847-445-8132

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	01/12/2017

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