Provider Demographics
NPI:1528387776
Name:HANOVER SMILE DENTAL P.C.
Entity Type:Organization
Organization Name:HANOVER SMILE DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PITHVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-550-3392
Mailing Address - Street 1:6602 BARRINGTON RD
Mailing Address - Street 2:G
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3900
Mailing Address - Country:US
Mailing Address - Phone:630-550-3392
Mailing Address - Fax:
Practice Address - Street 1:6602 BARRINGTON RD
Practice Address - Street 2:G
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-3900
Practice Address - Country:US
Practice Address - Phone:630-550-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental