Provider Demographics
NPI:1629614698
Name:ASHTON DENTAL PC
Entity Type:Organization
Organization Name:ASHTON DENTAL PC
Other - Org Name:OGDEN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-842-3705
Mailing Address - Street 1:1730 PARK ST STE 106
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2609
Mailing Address - Country:US
Mailing Address - Phone:630-842-3705
Mailing Address - Fax:630-596-5019
Practice Address - Street 1:1767 W OGDEN AVE STE 123
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-3956
Practice Address - Country:US
Practice Address - Phone:630-983-2600
Practice Address - Fax:630-983-2671
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHTON DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-25
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty