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NPI Code Detail

MEDICARE: VALLEY DENTAL CARE OF PLAINFIELD

MEDICARE: VALLEY DENTAL CARE OF PLAINFIELD
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 Dentistry019026612IL

General Provider Information

NPI Number : 1447572003
Entity Type Code : Organization
Provider Name (Legal Business Name) : VALLEY DENTAL CARE OF PLAINFIELD
Provider Business Mailing Address
First Line : 3405 ORCHARD RD
Second Line :
City : OSWEGO
State : IL
Zip : 60543-5005
Country : US
Telephone Number : 630-551-7000
Fax Number :
Provider Business Practice Location Address
First Line : 2356 S ROUTE 59
Second Line :
City : PLAINFIELD
State : IL
Zip : 60586-7756
Country : US
Telephone Number : 630-436-6800
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. SAMANTHA KOTHAPALLI
Credential : DMD
Telephone Number : 630-803-6431
Provider Enumeration Date : 02/24/2010
Last Update Date : 02/24/2010

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Directions to “VALLEY DENTAL CARE OF PLAINFIELD ” Practice Location

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