MEDICARE: AMEDCAO DENTAL CENTER

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	019024898	IL
2	122300000X	Dentist	019024608	IL

General Provider Information

NPI Number	:	1942454368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMEDCAO DENTAL CENTER

Provider Business Mailing Address
First Line	:	1000 GRAND CANYON PKWY
Second Line	:	SUITE 200
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1705
Country	:	US
Telephone Number	:	847-885-8780
Fax Number	:	847-885-9818

Provider Business Practice Location Address
First Line	:	1000 GRAND CANYON PKWY
Second Line	:	SUITE 200
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1705
Country	:	US
Telephone Number	:	847-885-8780
Fax Number	:	847-885-9818

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. GAURAV ASHOK PATEL
Credential	:	D.M.D.
Telephone Number	:	847-885-8780

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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Directions to “AMEDCAO DENTAL CENTER ” Practice Location

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