Provider Demographics
NPI:1295183424
Name:CD DENTAL CARE LTD
Entity Type:Organization
Organization Name:CD DENTAL CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AVANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGHAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-964-5056
Mailing Address - Street 1:452 N WESTERN AVE
Mailing Address - Street 2:B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:452 N WESTERN AVE
Practice Address - Street 2:B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1420
Practice Address - Country:US
Practice Address - Phone:312-964-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190286221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty