| Organization Name: | MAIN STREET DENTAL |
| NPI Number: | 1699952440 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMISH DESAI (PRESIDENT) |
| Mailing Address: | 340 W Main St Carpentersville |
| State: | IL US |
| Postal Code: | 601102844 |
| Phone Number: | 8477830303 |
| Fax Number: | 8477830311 |
| NPI Enumeration Date: | 01/23/2008 |
| NPI Last Update Date: | 01/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |