Provider Demographics
NPI:1326722364
Name:GOYAL, SHUCHI
Entity Type:Individual
Prefix:
First Name:SHUCHI
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 BIRCHDALE LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6550
Mailing Address - Country:US
Mailing Address - Phone:630-839-9778
Mailing Address - Fax:
Practice Address - Street 1:1195 BIRCHDALE LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6550
Practice Address - Country:US
Practice Address - Phone:630-839-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist