MEDICARE: NC TELEDENTISTRY

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1841900339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NC TELEDENTISTRY

Provider Business Mailing Address
First Line	:	211 E OHIO ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3262
Country	:	US
Telephone Number	:	630-437-1639
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E OHIO ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3262
Country	:	US
Telephone Number	:	630-437-1639
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	NISHA CHAUHAN
Credential	:
Telephone Number	:	630-437-1639

Provider Enumeration Date	:	11/25/2022
Last Update Date	:	11/25/2022

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Directions to “NC TELEDENTISTRY ” Practice Location

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