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Organization
KOKILA AVASTHI DDS PC
Active
Organization
KOKILA AVASTHI DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOKILA AVASTHI DDS (OWNER/DENTIST)
(847) 662-8341
Entity
Organization
Contact information
Practice address
401 S GREENLEAF AVE, STE #3, PARK CITY, IL 60085-5744
(847) 662-8341
Mailing address
401 S GREENLEAF AVE, STE 3, PARK CITY, IL 60085
(847) 662-8341
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
019022366
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114091303
INDIVIUAL NPI
IL
Enumeration date
10/12/2016
Last updated
10/12/2016
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