MEDICARE: APPLE DENTAL 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	1223G0001X	General Practice Dentistry		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831363134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLE DENTAL PC

Provider Business Mailing Address
First Line	:	1120 N MAIN STREET
Second Line	:	SUITE 2
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139
Country	:	US
Telephone Number	:	630-545-1500
Fax Number	:	630-545-1511

Provider Business Practice Location Address
First Line	:	1120 N MAIN ST
Second Line	:	SUITE 2
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139
Country	:	US
Telephone Number	:	630-545-1500
Fax Number	:	630-545-1511

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MADHURI D PUNATY
Credential	:	DMD
Telephone Number	:	630-545-1500

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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Directions to “APPLE DENTAL PC ” Practice Location

Language	Start Address	Practice Location

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