MEDICARE: ALLY DENTIST 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

General Provider Information

NPI Number	:	1639717358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLY DENTIST P.C.

Provider Business Mailing Address
First Line	:	605 W EUCLID AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-5301
Country	:	US
Telephone Number	:	847-305-4001
Fax Number	:	847-305-4002

Provider Business Practice Location Address
First Line	:	605 W EUCLID AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-5301
Country	:	US
Telephone Number	:	847-305-4001
Fax Number	:	847-305-4001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIPUL SINGHAL
Credential	:	DMD
Telephone Number	:	847-305-4001

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	12/12/2019

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