Provider Demographics
NPI:1588806046
Name:KRISHAN DENTAL LIMITED
Entity Type:Organization
Organization Name:KRISHAN DENTAL LIMITED
Other - Org Name:DOWNER PLACE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHWETA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-742-8471
Mailing Address - Street 1:2743 STOCKTON RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9470
Mailing Address - Country:US
Mailing Address - Phone:773-742-8471
Mailing Address - Fax:
Practice Address - Street 1:11 W DOWNER PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-5134
Practice Address - Country:US
Practice Address - Phone:630-892-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL179563Medicaid