Provider Demographics
NPI:1770193591
Name:URGENT DENTAL CENTER SW LLC
Entity Type:Organization
Organization Name:URGENT DENTAL CENTER SW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-894-0631
Mailing Address - Street 1:2907 KENTUCKY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-2103
Mailing Address - Country:US
Mailing Address - Phone:317-399-5771
Mailing Address - Fax:
Practice Address - Street 1:2907 KENTUCKY AVE STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-2103
Practice Address - Country:US
Practice Address - Phone:317-399-5771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty