Provider Demographics
NPI:1417657974
Name:DENTAL THEORY LTD
Entity Type:Organization
Organization Name:DENTAL THEORY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOTTUMUKKULA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-618-0882
Mailing Address - Street 1:1940 W GALENA BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4483
Mailing Address - Country:US
Mailing Address - Phone:630-892-7087
Mailing Address - Fax:
Practice Address - Street 1:1940 W GALENA BLVD STE 11
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4483
Practice Address - Country:US
Practice Address - Phone:630-892-7087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty