Healthcare Provider Details

I. General information

NPI: 1215302625
Provider Name (Legal Business Name): PREFERRED DENTISTRY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6428 N CALIFORNIA AVE
CHICAGO IL
60645-5209
US

IV. Provider business mailing address

6428 N CALIFORNIA AVE
CHICAGO IL
60645-5209
US

V. Phone/Fax

Practice location:
  • Phone: 773-942-7348
  • Fax: 312-584-0751
Mailing address:
  • Phone: 773-942-7348
  • Fax: 312-584-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PETER A. CONTOS
Title or Position: OFFICER
Credential: DDS
Phone: 847-804-9429