Provider Demographics
NPI:1215335054
Name:M. R. ADATIA DDS PC
Entity type:Organization
Organization Name:M. R. ADATIA DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKUNTALA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADATIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-769-4132
Mailing Address - Street 1:1013 SHEPPEY CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6109
Mailing Address - Country:US
Mailing Address - Phone:847-769-4133
Mailing Address - Fax:
Practice Address - Street 1:359 N FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3082
Practice Address - Country:US
Practice Address - Phone:630-898-0405
Practice Address - Fax:847-220-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty