Provider Demographics
NPI:1578737052
Name:PERAL DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:PERAL DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:VAHDANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-262-0500
Mailing Address - Street 1:2722 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3920
Mailing Address - Country:US
Mailing Address - Phone:773-262-0500
Mailing Address - Fax:773-262-2256
Practice Address - Street 1:2722 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3920
Practice Address - Country:US
Practice Address - Phone:773-262-0500
Practice Address - Fax:773-262-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190218351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty