Provider Demographics
NPI:1952025652
Name:AURORA DENTRIX NORTH AURORA
Entity Type:Organization
Organization Name:AURORA DENTRIX NORTH AURORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PURVI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-756-3767
Mailing Address - Street 1:111 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1129
Mailing Address - Country:US
Mailing Address - Phone:630-892-6515
Mailing Address - Fax:630-892-4979
Practice Address - Street 1:111 OAK ST
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1129
Practice Address - Country:US
Practice Address - Phone:630-892-6515
Practice Address - Fax:630-892-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1144517731Medicaid