Healthcare Provider Details

I. General information

NPI: 1619217965
Provider Name (Legal Business Name): INTEGRITY DENTAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 S WEBER RD UNIT D
BOLINGBROOK IL
60490-1549
US

IV. Provider business mailing address

276 S WEBER RD UNIT D
BOLINGBROOK IL
60490-1549
US

V. Phone/Fax

Practice location:
  • Phone: 630-312-8280
  • Fax:
Mailing address:
  • Phone: 630-312-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019028181
License Number StateIL

VIII. Authorized Official

Name: DR. YINGCHUN ZHU
Title or Position: PRESIDENT
Credential:
Phone: 734-945-7128