Healthcare Provider Details

I. General information

NPI: 1467462622
Provider Name (Legal Business Name): PEDIATRIC DENTAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 ARLINGTON HTS RD ST 150
BUFFALO GROVE IL
60089
US

IV. Provider business mailing address

195 ARLINGTON HTS RD ST 150
BUFFALO GROVE IL
60089
US

V. Phone/Fax

Practice location:
  • Phone: 847-537-7695
  • Fax: 847-537-6758
Mailing address:
  • Phone: 847-537-7695
  • Fax: 847-537-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. FRED S MARGOLIS
Title or Position: DENTIST OWNER
Credential: DDS
Phone: 847-537-1695