Provider Demographics
NPI:1033938501
Name:MEGHANA PRABHA DDS PC
Entity type:Organization
Organization Name:MEGHANA PRABHA DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:PRABHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-222-3760
Mailing Address - Street 1:1101 CREEK BEND DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3307
Mailing Address - Country:US
Mailing Address - Phone:847-222-3760
Mailing Address - Fax:
Practice Address - Street 1:2202 1/2 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3608
Practice Address - Country:US
Practice Address - Phone:847-870-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty