Healthcare Provider Details

I. General information

NPI: 1881859197
Provider Name (Legal Business Name): KIDS FIRST PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 WEATHERSTON CT.
ELGIN IL
60123-2019
US

IV. Provider business mailing address

1534 WEATHERSTONE LN
ELGIN IL
60123-2019
US

V. Phone/Fax

Practice location:
  • Phone: 847-717-5437
  • Fax:
Mailing address:
  • Phone: 847-717-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number019027105
License Number StateIL

VIII. Authorized Official

Name: DR. MATT J KARSTEN
Title or Position: DOCTOR/OWNER
Credential: DMD
Phone: 847-717-5437