Healthcare Provider Details

I. General information

NPI: 1134391055
Provider Name (Legal Business Name): HEALTHCARE FOR DENTAL SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 W PETERSON AVE SUITE 305
CHICAGO IL
60659-3270
US

IV. Provider business mailing address

3550 W PETERSON AVE SUITE 305
CHICAGO IL
60659-3270
US

V. Phone/Fax

Practice location:
  • Phone: 773-267-1199
  • Fax: 773-267-5599
Mailing address:
  • Phone: 773-267-1199
  • Fax: 773-267-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. BERNARD M. COLE
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 773-267-1199