Healthcare Provider Details

I. General information

NPI: 1316892904
Provider Name (Legal Business Name): GDA FOR KIDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 LINCOLN HWY STE 111
OLYMPIA FIELDS IL
60461-1938
US

IV. Provider business mailing address

2555 LINCOLN HWY STE 111
OLYMPIA FIELDS IL
60461-1938
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-0668
  • Fax: 708-843-0656
Mailing address:
  • Phone: 708-679-0668
  • Fax: 708-843-0656

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: RONNIE A GORDON SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 708-466-2374