Provider Demographics
NPI:1346411634
Name:ADATIA, SHAKUNTALA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAKUNTALA
Middle Name:M
Last Name:ADATIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 SHEPPEY CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6109
Mailing Address - Country:US
Mailing Address - Phone:630-898-0405
Mailing Address - Fax:630-898-0406
Practice Address - Street 1:359 N FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3082
Practice Address - Country:US
Practice Address - Phone:847-769-4133
Practice Address - Fax:630-544-5708
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice