Provider Demographics
NPI:1205376134
Name:SATNAM DENTAL CARE SC
Entity Type:Organization
Organization Name:SATNAM DENTAL CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VINIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-704-1974
Mailing Address - Street 1:3303 S HALSTED ST STE 207
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6877
Mailing Address - Country:US
Mailing Address - Phone:773-704-1974
Mailing Address - Fax:
Practice Address - Street 1:721 W 15TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-5139
Practice Address - Country:US
Practice Address - Phone:773-704-1974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-25
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1184826174OtherNPI NUMBER