MEDICARE: DR. AMIT PITHVA D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19027372	IL
2	1223G0001X	General Practice Dentistry	19027372	IL

General Provider Information

NPI Number	:	1740486265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIT PITHVA D.D.S.

Provider Business Mailing Address
First Line	:	1660 GLEN ELLYN RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2504
Country	:	US
Telephone Number	:	630-474-0976
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 GLEN ELLYN RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2504
Country	:	US
Telephone Number	:	630-474-0976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	08/01/2019

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