Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019027739 | IL |
NPI | 1003070798 |
---|---|
Provider Name | Dr. Roshan P Parikh |
First Address | Olympia Fields, IL 60461-1936 |
Second Address | Olympia Fields, IL 60461-1936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 21/05/2014 |