Provider Demographics
NPI:1427874593
Name:SANDWICH DENTISTRY LLC
Entity type:Organization
Organization Name:SANDWICH DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHAN
Authorized Official - Middle Name:VIKRAM
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-766-0144
Mailing Address - Street 1:10735 CLOCKTOWER DR, UNIT 303
Mailing Address - Street 2:UNIT 303
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:832-766-0144
Mailing Address - Fax:
Practice Address - Street 1:1 E COUNTY LINE RD STE A
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-9574
Practice Address - Country:US
Practice Address - Phone:832-766-0144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental