Provider Demographics
NPI:1053496521
Name:CONCORD DENTAL PC
Entity Type:Organization
Organization Name:CONCORD DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOJANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-942-8110
Mailing Address - Street 1:498 HILLSIDE AVE STE 1E
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4546
Mailing Address - Country:US
Mailing Address - Phone:630-942-8110
Mailing Address - Fax:630-942-8272
Practice Address - Street 1:498 HILLSIDE AVE STE 1E
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4546
Practice Address - Country:US
Practice Address - Phone:630-942-8110
Practice Address - Fax:630-942-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty