Provider Demographics
NPI:1457688897
Name:UDAY PHATAK D.D.S. P.C.
Entity Type:Organization
Organization Name:UDAY PHATAK D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHATAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-541-0008
Mailing Address - Street 1:642A N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-2353
Mailing Address - Country:US
Mailing Address - Phone:847-541-0008
Mailing Address - Fax:847-541-0009
Practice Address - Street 1:642A N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-2353
Practice Address - Country:US
Practice Address - Phone:847-541-0008
Practice Address - Fax:847-541-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019018029261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental