Provider Demographics
NPI:1821462599
Name:DST DENTAL, LLC
Entity Type:Organization
Organization Name:DST DENTAL, LLC
Other - Org Name:NORTH AVE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DHAVAL
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-965-8133
Mailing Address - Street 1:1933 FRANCISCAN WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-6201
Mailing Address - Country:US
Mailing Address - Phone:630-231-4500
Mailing Address - Fax:
Practice Address - Street 1:1933 FRANCISCAN WAY
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-6201
Practice Address - Country:US
Practice Address - Phone:630-231-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty