Provider Demographics
NPI:1346790565
Name:KOKILA AVASTHI DDS PC
Entity Type:Organization
Organization Name:KOKILA AVASTHI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KOKILA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVASTHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-662-8341
Mailing Address - Street 1:401 S GREENLEAF AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:PARK CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-662-8341
Mailing Address - Fax:
Practice Address - Street 1:401 S GREENLEAF AVE
Practice Address - Street 2:STE #3
Practice Address - City:PARK CITY
Practice Address - State:IL
Practice Address - Zip Code:60085-5744
Practice Address - Country:US
Practice Address - Phone:847-662-8341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022366261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1114091303OtherINDIVIUAL NPI