Provider Demographics
NPI:1720664436
Name:WASHINGTON DENTAL STUDIO
Entity Type:Organization
Organization Name:WASHINGTON DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHAN
Authorized Official - Middle Name:VIKRAM
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-766-0144
Mailing Address - Street 1:10735 CLOCKTOWER DR
Mailing Address - Street 2:UNIT 303
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:832-766-0144
Mailing Address - Fax:
Practice Address - Street 1:1003 S WASHINGTON ST STE 225
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7444
Practice Address - Country:US
Practice Address - Phone:832-766-0144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty