Provider Demographics
NPI:1356668867
Name:ADVANCED PERIODONTICS AND IMPLANTS, LTD
Entity Type:Organization
Organization Name:ADVANCED PERIODONTICS AND IMPLANTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKISHA
Authorized Official - Middle Name:NANDINI
Authorized Official - Last Name:JODHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-512-7410
Mailing Address - Street 1:500 DAVIS ST STE 104
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4600
Mailing Address - Country:US
Mailing Address - Phone:847-512-7410
Mailing Address - Fax:
Practice Address - Street 1:900 CHICAGO AVE
Practice Address - Street 2:UNIT 702
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1872
Practice Address - Country:US
Practice Address - Phone:312-854-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental