Healthcare Provider Details

I. General information

NPI: 1336075233
Provider Name (Legal Business Name): DENALI DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590A BANKVIEW DR.
FRANKFORT IL
60423
US

IV. Provider business mailing address

590 BANKVIEW DR STE A
FRANKFORT IL
60423-1858
US

V. Phone/Fax

Practice location:
  • Phone: 708-301-9401
  • Fax:
Mailing address:
  • Phone: 708-301-9401
  • Fax: 708-301-8515

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: DR. EDWARD J KIRSCH
Title or Position: SOLE MEMBER
Credential: DDS
Phone: 708-301-9401