Healthcare Provider Details

I. General information

NPI: 1578490579
Provider Name (Legal Business Name): FPD GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S RANDALL RD STE G
ELGIN IL
60123-4607
US

IV. Provider business mailing address

400 S RANDALL RD STE G
ELGIN IL
60123-4607
US

V. Phone/Fax

Practice location:
  • Phone: 224-629-4125
  • Fax: 224-601-8506
Mailing address:
  • Phone: 224-629-4125
  • Fax: 224-601-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN BAIK
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 847-372-5818