Healthcare Provider Details

I. General information

NPI: 1396669719
Provider Name (Legal Business Name): IL DENTIST PARTNERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N STATE ST
CHICAGO IL
60654-3820
US

IV. Provider business mailing address

111 E WACKER DR
CHICAGO IL
60601-3713
US

V. Phone/Fax

Practice location:
  • Phone: 312-867-8766
  • Fax: 312-867-8775
Mailing address:
  • Phone: 312-867-8766
  • Fax: 312-867-8775

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 YVONNE BUSCEMI
Title or Position: VICE PRESIDENT, REVENUE CYCLE
Credential:
Phone: 586-557-2748