Provider Demographics
NPI:1942454368
Name:AMEDCAO DENTAL CENTER
Entity Type:Organization
Organization Name:AMEDCAO DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAURAV
Authorized Official - Middle Name:ASHOK
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-885-8780
Mailing Address - Street 1:1000 GRAND CANYON PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1705
Mailing Address - Country:US
Mailing Address - Phone:847-885-8780
Mailing Address - Fax:847-885-9818
Practice Address - Street 1:1000 GRAND CANYON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1705
Practice Address - Country:US
Practice Address - Phone:847-885-8780
Practice Address - Fax:847-885-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024608122300000X
IL019024898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty