Healthcare Provider Details

I. General information

NPI: 1891076709
Provider Name (Legal Business Name): A PLUS ENDODONTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24228 W. LOCKPORT STREET SUITE:- 102
PLAINFIELD IL
60544
US

IV. Provider business mailing address

24228 W. LOCKPORT STREET SUITE:- 102
PLAINFIELD IL
60544
US

V. Phone/Fax

Practice location:
  • Phone: 815-577-1883
  • Fax: 815-577-2010
Mailing address:
  • Phone: 815-577-1883
  • Fax: 815-577-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number019026438
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number021002132
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FUWAD AL-SABEK
Title or Position: PRESIDENT
Credential: DMD, MS
Phone: 630-696-6173