Healthcare Provider Details

I. General information

NPI: 1821765751
Provider Name (Legal Business Name): DENTAL ESSENCE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 W. LAKE STREET SUITE 102
ADDISON IL
60101
US

IV. Provider business mailing address

1576 W. LAKE STREET SUITE 102
ADDISON IL
60101
US

V. Phone/Fax

Practice location:
  • Phone: 630-250-0333
  • Fax: 630-250-0903
Mailing address:
  • Phone: 630-250-0333
  • Fax: 630-250-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. PAUL N GREICO
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 630-250-0333