Healthcare Provider Details

I. General information

NPI: 1134150956
Provider Name (Legal Business Name): DDS ASSOC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 GOLF RD
SKOKIE IL
60076-1224
US

IV. Provider business mailing address

4711 GOLF RD #912
SKOKIE IL
60076
US

V. Phone/Fax

Practice location:
  • Phone: 847-676-3500
  • Fax:
Mailing address:
  • Phone: 847-676-3500
  • Fax: 847-676-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES D BENZ
Title or Position: PARTNER SECRETARY
Credential: DDS
Phone: 847-676-3500