Organization Name: | HANOVER SMILE DENTAL P.C. |
NPI Number: | 1528387776 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AMIT PITHVA (PRESIDENT) |
Mailing Address: | 6602 Barrington Rd G Hanover Park |
State: | IL US |
Postal Code: | 601333900 |
Phone Number: | 6305503392 |
Fax Number: | |
NPI Enumeration Date: | 05/27/2010 |
NPI Last Update Date: | 05/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |