Organization Name: | VPDENTAL LLC |
NPI Number: | 1346355856 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AJITHA PARUCHURI (DENTIST) |
Mailing Address: | 956 N Neltnor Blvd Suite 316 West Chicago |
State: | IL US |
Postal Code: | 601855982 |
Phone Number: | 6302937777 |
Fax Number: | 6302937773 |
NPI Enumeration Date: | 08/21/2006 |
NPI Last Update Date: | 06/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 019026362 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |