MEDICARE: ACDI GLENVIEW,LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019-013583	IL
2	1223G0001X	General Practice Dentistry	019-027311	IL
3	1223G0001X	General Practice Dentistry	019-020580	IL

General Provider Information

NPI Number	:	1356578140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACDI GLENVIEW,LLC.

Provider Business Mailing Address
First Line	:	2501 COMPASS RD
Second Line	:	130
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8000
Country	:	US
Telephone Number	:	847-730-3726
Fax Number	:	847-730-3734

Provider Business Practice Location Address
First Line	:	2000 SPRING RD
Second Line	:	600
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1804
Country	:	US
Telephone Number	:	630-571-2500
Fax Number	:	630-571-7100

Authorized Official
Title or Position	:	FANACIAL OFFICER
Name	:	ZUZANA VITKOVA
Credential	:
Telephone Number	:	630-571-2500

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	06/18/2009

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