Provider Demographics
NPI:1881717643
Name:G B VAIDYA DDS PC
Entity type:Organization
Organization Name:G B VAIDYA DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIRISH
Authorized Official - Middle Name:BAPALAL
Authorized Official - Last Name:VAIDYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-533-4323
Mailing Address - Street 1:3900 W MADISON ST
Mailing Address - Street 2:SUITE #12
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624
Mailing Address - Country:US
Mailing Address - Phone:773-533-4323
Mailing Address - Fax:773-533-0531
Practice Address - Street 1:3900 W MADISON ST
Practice Address - Street 2:SUITE #12
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624
Practice Address - Country:US
Practice Address - Phone:773-533-4323
Practice Address - Fax:773-533-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty