Provider Demographics
NPI:1891040176
Name:FOREST PARK DENTAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:FOREST PARK DENTAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHMIKANT
Authorized Official - Middle Name:
Authorized Official - Last Name:VORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-209-1900
Mailing Address - Street 1:7742 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1404
Mailing Address - Country:US
Mailing Address - Phone:708-209-1900
Mailing Address - Fax:708-209-1973
Practice Address - Street 1:7742 MADISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1404
Practice Address - Country:US
Practice Address - Phone:708-209-1900
Practice Address - Fax:708-209-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017346261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental