Provider Demographics
NPI:1518303627
Name:OPULENT DENTISTRY
Entity Type:Organization
Organization Name:OPULENT DENTISTRY
Other - Org Name:SIMPLY TEETH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-870-1111
Mailing Address - Street 1:905 E RAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2570
Mailing Address - Country:US
Mailing Address - Phone:847-870-1111
Mailing Address - Fax:847-749-4789
Practice Address - Street 1:905 E RAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2570
Practice Address - Country:US
Practice Address - Phone:847-870-1111
Practice Address - Fax:847-749-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028049261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental