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NPI Code Detail

MEDICARE: 5TH AVE DENTAL INC.

MEDICARE: 5TH AVE DENTAL INC.
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
11223G0001XGeneral Practice Dentistry12011381IN

General Provider Information

NPI Number : 1396136511
Entity Type Code : Organization
Provider Name (Legal Business Name) : 5TH AVE DENTAL INC.
Provider Business Mailing Address
First Line : 814 W CHICAGO AVE
Second Line :
City : EAST CHICAGO
State : IN
Zip : 46312-3307
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1619 W 5TH AVE
Second Line :
City : GARY
State : IN
Zip : 46404-1506
Country : US
Telephone Number : 708-359-2068
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. AMIT SAPARIA
Credential : D.D.S.
Telephone Number : 708-359-2068
Provider Enumeration Date : 02/10/2015
Last Update Date : 02/10/2015

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Directions to “5TH AVE DENTAL INC. ” Practice Location

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