Healthcare Provider Details

I. General information

NPI: 1376452748
Provider Name (Legal Business Name): IL DENTIST PARTNERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 W ILLINOIS ST
CHICAGO IL
60654-7677
US

IV. Provider business mailing address

PO BOX 737216
CHICAGO IL
60673-6483
US

V. Phone/Fax

Practice location:
  • Phone: 312-836-1166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 OF REVENUE CYCLE
Credential:
Phone: 586-557-2748