Provider Demographics
NPI:1255090734
Name:PROSPERRITTA DENTAL, PLLC
Entity type:Organization
Organization Name:PROSPERRITTA DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIVAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:224-558-4897
Mailing Address - Street 1:545 S YORK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3000
Mailing Address - Country:US
Mailing Address - Phone:630-766-0115
Mailing Address - Fax:630-766-1164
Practice Address - Street 1:545 S YORK RD STE 200
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3000
Practice Address - Country:US
Practice Address - Phone:630-766-0115
Practice Address - Fax:630-766-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty