Provider Demographics
NPI:1740739135
Name:PARDESI DENTAL LLC
Entity Type:Organization
Organization Name:PARDESI DENTAL LLC
Other - Org Name:OLD TOWN DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZAID
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-312-8721
Mailing Address - Street 1:1250 S MICHIGAN AVE
Mailing Address - Street 2:APT 2505
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2548
Mailing Address - Country:US
Mailing Address - Phone:847-312-8721
Mailing Address - Fax:
Practice Address - Street 1:526 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BEECHER
Practice Address - State:IL
Practice Address - Zip Code:60401-3698
Practice Address - Country:US
Practice Address - Phone:708-946-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0301521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty