Provider Demographics
NPI:1902587991
Name:MITTAL, ROOPALI (DDS)
Entity type:Individual
Prefix:DR
First Name:ROOPALI
Middle Name:
Last Name:MITTAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3347 TIMBER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-3534
Mailing Address - Country:US
Mailing Address - Phone:630-414-5590
Mailing Address - Fax:
Practice Address - Street 1:6 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5446
Practice Address - Country:US
Practice Address - Phone:708-403-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034577122300000X
FL284771223G0001X, 122300000X
IN12014557A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice