Provider Demographics
NPI:1770280331
Name:GOPE DENTAL P.C
Entity type:Organization
Organization Name:GOPE DENTAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-542-3589
Mailing Address - Street 1:69 W KENNEDY LN
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4586
Mailing Address - Country:US
Mailing Address - Phone:301-542-3589
Mailing Address - Fax:
Practice Address - Street 1:9042 COLUMBIA AVE STE A
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2928
Practice Address - Country:US
Practice Address - Phone:301-542-3589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1669929931Medicaid
IL1639511017Medicaid