Provider Demographics
NPI:1366736381
Name:ADVANI, VISHAL JAGDISH (DDS)
Entity type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:JAGDISH
Last Name:ADVANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 TURNER AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3955
Mailing Address - Country:US
Mailing Address - Phone:847-437-3250
Mailing Address - Fax:847-437-3251
Practice Address - Street 1:70 TURNER AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3955
Practice Address - Country:US
Practice Address - Phone:847-437-3250
Practice Address - Fax:847-437-3251
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0291961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice