Provider Demographics
NPI:1528303484
Name:ELITE PERIODONTICS PC
Entity type:Organization
Organization Name:ELITE PERIODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:630-452-3194
Mailing Address - Street 1:2124 OGDEN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7514
Mailing Address - Country:US
Mailing Address - Phone:630-585-6100
Mailing Address - Fax:630-585-6107
Practice Address - Street 1:2124 OGDEN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7514
Practice Address - Country:US
Practice Address - Phone:630-585-6100
Practice Address - Fax:630-585-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190279021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty