Individual
GAURAV AIDASANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4721 S KEDZIE AVE, CHICAGO, IL 60632-3001
(773) 847-4444
Mailing address
2 E ERIE ST APT 3512, CHICAGO, IL 60611-3161
(310) 351-2918
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.034550
IL
Other
Enumeration date
07/18/2023
Last updated
08/08/2023
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