Provider Demographics
NPI:1265794747
Name:VINAYAK DENTAL, P.C.
Entity type:Organization
Organization Name:VINAYAK DENTAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-362-9987
Mailing Address - Street 1:5931 STEWART DR
Mailing Address - Street 2:UNIT#1012
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-3158
Mailing Address - Country:US
Mailing Address - Phone:203-362-9987
Mailing Address - Fax:
Practice Address - Street 1:5 N ROOT ST
Practice Address - Street 2:UNIT#105
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3429
Practice Address - Country:US
Practice Address - Phone:203-362-9987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0279691223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty