Provider Demographics
NPI:1356707764
Name:FAIRVIEW DENTAL CARE GROUP P.C.
Entity type:Organization
Organization Name:FAIRVIEW DENTAL CARE GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-852-5353
Mailing Address - Street 1:6317 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2887
Mailing Address - Country:US
Mailing Address - Phone:630-852-5353
Mailing Address - Fax:630-968-0958
Practice Address - Street 1:6317 FAIRVIEW AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2887
Practice Address - Country:US
Practice Address - Phone:630-852-5353
Practice Address - Fax:630-968-0958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT LAKES DENTAL PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty