Provider Demographics
NPI:1215548771
Name:MEDA DENTAL II LLC
Entity Type:Organization
Organization Name:MEDA DENTAL II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SATHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDA NAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-329-2525
Mailing Address - Street 1:2735 HASSERT BLVD STE 159
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5205
Mailing Address - Country:US
Mailing Address - Phone:630-352-4141
Mailing Address - Fax:630-352-4430
Practice Address - Street 1:2735 HASSERT BLVD STE 159
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5205
Practice Address - Country:US
Practice Address - Phone:630-352-4141
Practice Address - Fax:630-352-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental