Provider Demographics
NPI:1669735767
Name:A BRUSH WITH DENTISTRY, P.C.
Entity type:Organization
Organization Name:A BRUSH WITH DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILEE
Authorized Official - Middle Name:SHASHI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-217-4490
Mailing Address - Street 1:223 GRAND OAKS LN
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3220
Mailing Address - Country:US
Mailing Address - Phone:312-217-4490
Mailing Address - Fax:
Practice Address - Street 1:100 N PEORIA AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-2027
Practice Address - Country:US
Practice Address - Phone:815-288-1418
Practice Address - Fax:815-288-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0274151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty