Provider Demographics
NPI:1891196580
Name:PVR DENTAL PC
Entity Type:Organization
Organization Name:PVR DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYADARSHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOINPALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-338-7080
Mailing Address - Street 1:483 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2907
Mailing Address - Country:US
Mailing Address - Phone:847-230-9394
Mailing Address - Fax:
Practice Address - Street 1:410 GREENBAY RD.
Practice Address - Street 2:SUITE #1
Practice Address - City:HIGHWOOD
Practice Address - State:IL
Practice Address - Zip Code:60040
Practice Address - Country:US
Practice Address - Phone:847-230-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190280571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty