Individual
SIDHARTH MOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSD, BDS, BS
Contact information
Practice address
964 BROOKFOREST AVE, SHOREWOOD, IL 60404-8807
(815) 254-1177
Mailing address
964 BROOKFOREST AVE, SHOREWOOD, IL 60404-8807
(864) 940-8987
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.031930
IL
1223P0700X
Prosthodontics
Primary
019.031930
IL
Other
Enumeration date
11/16/2018
Last updated
10/06/2019
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