Provider Demographics
NPI:1215100508
Name:LISLE DENTAL CENTER P.C.
Entity type:Organization
Organization Name:LISLE DENTAL CENTER P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMEET
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-368-1920
Mailing Address - Street 1:4712 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1749
Mailing Address - Country:US
Mailing Address - Phone:630-964-0944
Mailing Address - Fax:
Practice Address - Street 1:4712 MAIN ST
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1749
Practice Address - Country:US
Practice Address - Phone:630-964-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty