Individual
GAURAV PRAVINCHANDRA MODI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1174 W MAPLE AVE, MUNDELEIN, IL 60060-1438
(847) 305-4700
Mailing address
272 LE PARC CIR, BUFFALO GROVE, IL 60089-6903
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.037316
IL
Other
Enumeration date
07/15/2026
Last updated
07/15/2026
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