Healthcare Provider Details

I. General information

NPI: 1538305610
Provider Name (Legal Business Name): JEFFREY A. HALPERN, DDS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LEE ST SUITE 640
DES PLAINES IL
60016-4539
US

IV. Provider business mailing address

701 LEE ST SUITE 640
DES PLAINES IL
60016-4539
US

V. Phone/Fax

Practice location:
  • Phone: 847-827-6300
  • Fax: 847-827-6306
Mailing address:
  • Phone: 847-827-6300
  • Fax: 847-827-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number019022874(021001595)
License Number StateIL

VIII. Authorized Official

Name: DR. JEFFREY HALPERN
Title or Position: PRESIDENT
Credential: DDS
Phone: 847-827-6300