Healthcare Provider Details

I. General information

NPI: 1760633564
Provider Name (Legal Business Name): KIDS PLUS PEDIATRIC DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 GRAND CANYON PKWY SUITE 120
HOFFMAN ESTATES IL
60169-1739
US

IV. Provider business mailing address

990 GRAND CANYON PKWY SUITE 120
HOFFMAN ESTATES IL
60169-1739
US

V. Phone/Fax

Practice location:
  • Phone: 847-882-2555
  • Fax: 847-882-9260
Mailing address:
  • Phone: 847-882-2555
  • Fax: 847-882-9260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number019023892
License Number StateIL

VIII. Authorized Official

Name: MELISSA J HEALY
Title or Position: RECEPTIONIST
Credential:
Phone: 773-772-7373