Healthcare Provider Details

I. General information

NPI: 1306752225
Provider Name (Legal Business Name): IL DENTIST PARTNERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 W DIVISION ST
CHICAGO IL
60622-3117
US

IV. Provider business mailing address

PO BOX 737216
CHICAGO IL
60673-7216
US

V. Phone/Fax

Practice location:
  • Phone: 773-227-6721
  • Fax:
Mailing address:
  • Phone: 773-227-6721
  • Fax: 773-276-3279

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: PAMELA BUSCEMI
Title or Position: VP -REVENUE CYCLE
Credential:
Phone: 586-557-2748