Provider Demographics
NPI:1598919011
Name:ROSHAN P. PARIKH, D.D.S. M.B.A. P.C.
Entity Type:Organization
Organization Name:ROSHAN P. PARIKH, D.D.S. M.B.A. P.C.
Other - Org Name:OLYMPIA FIELDS DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MBA
Authorized Official - Phone:847-833-4955
Mailing Address - Street 1:2555 LINCOLN HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1936
Mailing Address - Country:US
Mailing Address - Phone:708-481-1818
Mailing Address - Fax:708-481-1233
Practice Address - Street 1:2555 LINCOLN HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1936
Practice Address - Country:US
Practice Address - Phone:708-481-1818
Practice Address - Fax:708-481-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190277391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty