Kokila Avasthi, DDS
Individual provider Active NPI Dentist · Park City, IL
NPI 1114091303 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1114091303
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- Practice address
- 401 Greenleaf Ave
Suite 3
Park City, IL 60085-5744 - Phone
- (847) 662-8341
- Fax
- (847) 662-8360
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-022366 | IL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | IL | Yes |
Addresses
Primary practice location
401 Greenleaf Ave
Suite 3
Park City, IL 60085-5744
Mailing address
401 Greenleaf Ave
Suite 3
Park City, IL 60085-5744
Phone (847) 662-8341
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1005399 | Medicaid | IL |
Other providers in Park City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.