MEDICARE: LV DENTISTRY, PC

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	122300000X	Dentist	019025118	IL

General Provider Information

NPI Number	:	1700132230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LV DENTISTRY, PC

Provider Business Mailing Address
First Line	:	1753 W ALGONQUIN RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-5401
Country	:	US
Telephone Number	:	847-952-1905
Fax Number	:	847-952-0828

Provider Business Practice Location Address
First Line	:	1753 W ALGONQUIN RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-5401
Country	:	US
Telephone Number	:	847-952-1905
Fax Number	:	847-952-0828

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. BINDU GULATI
Credential	:	DDS
Telephone Number	:	630-803-8883

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	08/02/2012

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