Provider Demographics
NPI:1922486521
Name:KAVEH N. ADEL, D.D.S., P.C.
Entity Type:Organization
Organization Name:KAVEH N. ADEL, D.D.S., P.C.
Other - Org Name:NAPERVILLE FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:NASIREDDIN
Authorized Official - Last Name:ADEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-369-8950
Mailing Address - Street 1:612 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3237
Mailing Address - Country:US
Mailing Address - Phone:630-369-8950
Mailing Address - Fax:630-369-7342
Practice Address - Street 1:612 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3237
Practice Address - Country:US
Practice Address - Phone:630-369-8950
Practice Address - Fax:630-369-7342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024954122300000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019-024954OtherILLINOIS STATE DENTAL LICENSE
1649342668OtherINDIVIDUAL NPI