Provider Demographics
NPI:1679997431
Name:DOWNTOWN DENTAL & IMPLANTS OF OSWEGO INC.
Entity Type:Organization
Organization Name:DOWNTOWN DENTAL & IMPLANTS OF OSWEGO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-554-1855
Mailing Address - Street 1:60 MAIN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543
Mailing Address - Country:US
Mailing Address - Phone:630-554-1855
Mailing Address - Fax:630-554-6185
Practice Address - Street 1:60 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8594
Practice Address - Country:US
Practice Address - Phone:630-554-1855
Practice Address - Fax:630-554-6185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty