Healthcare Provider Details

I. General information

NPI: 1578499091
Provider Name (Legal Business Name): CHICAGO PEDIATRIC DENTISTRY AND ORTHODONTICS - PREMIER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 EASTERN AVE
AURORA IL
60505-3217
US

IV. Provider business mailing address

1136 S DELANO CT W STE B202
CHICAGO IL
60605-3734
US

V. Phone/Fax

Practice location:
  • Phone: 630-820-2600
  • Fax:
Mailing address:
  • Phone: 630-746-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN A WELKE
Title or Position: OWNER
Credential: DDS
Phone: 630-886-1780