Healthcare Provider Details

I. General information

NPI: 1417581893
Provider Name (Legal Business Name): SCOTT E BERDELLE DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 GRAND CANYON PKWY
HOFFMAN ESTATES IL
60169-1739
US

IV. Provider business mailing address

1005 DIVISION ST
BARRINGTON IL
60010-5012
US

V. Phone/Fax

Practice location:
  • Phone: 847-885-4343
  • Fax:
Mailing address:
  • Phone: 847-612-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT EDWARD BERDELLE
Title or Position: DENTIST
Credential:
Phone: 847-885-4343