Provider Demographics
NPI:1598463390
Name:32 DENTAL 4U
Entity Type:Organization
Organization Name:32 DENTAL 4U
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASUDHA
Authorized Official - Middle Name:KARTEEKA
Authorized Official - Last Name:SUNKARA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-212-4340
Mailing Address - Street 1:3218 KIRCHOFF ROAD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008
Mailing Address - Country:US
Mailing Address - Phone:847-305-4041
Mailing Address - Fax:847-305-2674
Practice Address - Street 1:3218 KIRCHOFF ROAD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008
Practice Address - Country:US
Practice Address - Phone:847-305-4041
Practice Address - Fax:847-305-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1184174203Medicaid