Provider Demographics
NPI:1235968587
Name:DENTAL 360 PULASKI 67 LLC
Entity type:Organization
Organization Name:DENTAL 360 PULASKI 67 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:PARVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-294-1770
Mailing Address - Street 1:2759 W 55TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2251
Mailing Address - Country:US
Mailing Address - Phone:773-776-5277
Mailing Address - Fax:773-776-5278
Practice Address - Street 1:2759 W 55TH ST STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2251
Practice Address - Country:US
Practice Address - Phone:773-776-5277
Practice Address - Fax:773-776-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty