Provider Demographics
NPI:1366191942
Name:BLUE SKY DENTAL PLLC
Entity type:Organization
Organization Name:BLUE SKY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-431-3012
Mailing Address - Street 1:685 JAMISON LN
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4128
Mailing Address - Country:US
Mailing Address - Phone:847-431-3012
Mailing Address - Fax:
Practice Address - Street 1:7702 CASS AVE STE 210
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5109
Practice Address - Country:US
Practice Address - Phone:630-810-0444
Practice Address - Fax:630-810-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental