PA Dental Incorporated

NPI #1013120005 in Waukegan, Illinois

Provider Information

NPI Number: 1013120005
Entity Type: Organization
Organization Name: PA Dental Incorporated
Primary Specialty: Dentist - General Practice
Enumeration Date: May 7, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 2605A GRAND AVE
City: Waukegan
State: Illinois
ZIP Code: 60085-2410
Phone: (847) 244-7779

Authorized Official

Name: DR. AJITHA PARUCHURI, D.M.D.
Title: PRESIDENT
Phone: (630) 229-5469

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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