MEDICARE: DR. VISHAL JAGDISH ADVANI D.D.S.

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	1223G0001X	General Practice Dentistry	019.029196	IL

General Provider Information

NPI Number	:	1366736381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VISHAL JAGDISH ADVANI D.D.S.

Provider Business Mailing Address
First Line	:	70 TURNER AVE
Second Line	:	SUITE #1
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3955
Country	:	US
Telephone Number	:	847-437-3250
Fax Number	:	847-437-3251

Provider Business Practice Location Address
First Line	:	70 TURNER AVE
Second Line	:	SUITE #1
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3955
Country	:	US
Telephone Number	:	847-437-3250
Fax Number	:	847-437-3251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	12/13/2012

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