Provider Demographics
NPI:1992974141
Name:SHREENATH KESHAV SHIVANI PARUL DEVI DENTAL GROUP
Entity type:Organization
Organization Name:SHREENATH KESHAV SHIVANI PARUL DEVI DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PRASHANT
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-913-8206
Mailing Address - Street 1:150 W HALF DAY ROAD
Mailing Address - Street 2:STE 203
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6591
Mailing Address - Country:US
Mailing Address - Phone:847-913-8206
Mailing Address - Fax:847-913-8224
Practice Address - Street 1:150 W HALF DAY ROAD
Practice Address - Street 2:STE 203
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6591
Practice Address - Country:US
Practice Address - Phone:847-913-8206
Practice Address - Fax:847-913-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty