MEDICARE: GLENDALE HEIGHTS 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	1223G0001X	General Practice Dentistry	019028336	IL

General Provider Information

NPI Number	:	1447644828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE HEIGHTS DENTAL P.C.

Provider Business Mailing Address
First Line	:	1177 BLOOMINGDALE RD STE B
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3402
Country	:	US
Telephone Number	:	630-866-6000
Fax Number	:	630-949-2187

Provider Business Practice Location Address
First Line	:	1177 BLOOMINGDALE RD STE B
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3402
Country	:	US
Telephone Number	:	630-866-6000
Fax Number	:	630-949-2187

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BHUMIKA SHAH PATEL
Credential	:	DDS
Telephone Number	:	630-866-6000

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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