Healthcare Provider Details

I. General information

NPI: 1396957361
Provider Name (Legal Business Name): PREFERRED DENTAL GROUP, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
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: 773-293-6910
  • Fax: 773-293-6852
Mailing address:
  • Phone: 773-293-6910
  • Fax: 773-293-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019026750
License Number StateIL

VIII. Authorized Official

Name: DR. PETER A CONTOS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 847-804-9429