Provider Demographics
NPI:1902202930
Name:RESHMA DHAKE DDS LTD
Entity Type:Organization
Organization Name:RESHMA DHAKE DDS LTD
Other - Org Name:FOREVER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RESHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-685-2135
Mailing Address - Street 1:5738 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5208
Mailing Address - Country:US
Mailing Address - Phone:773-685-2135
Mailing Address - Fax:
Practice Address - Street 1:5738 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5208
Practice Address - Country:US
Practice Address - Phone:773-685-2135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESHMA DHAKE DDS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty