Healthcare Provider Details

I. General information

NPI: 1003246927
Provider Name (Legal Business Name): ALL KIDS DENTAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 N 19TH AVE
MELROSE PARK IL
60160-2039
US

IV. Provider business mailing address

4849 N MILWAUKEE AVE STE 403
CHICAGO IL
60630-2169
US

V. Phone/Fax

Practice location:
  • Phone: 708-498-4410
  • Fax:
Mailing address:
  • Phone: 773-302-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: EMILY VANNEY
Title or Position: CO-OWNER/PRESIDENT
Credential: DDS
Phone: 312-375-0325