Healthcare Provider Details

I. General information

NPI: 1255340402
Provider Name (Legal Business Name): HINSDALE PERIODONTICS & ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 N CASS AVE
WESTMONT IL
60559-1394
US

IV. Provider business mailing address

PO BOX 4656
OAK BROOK IL
60522-4656
US

V. Phone/Fax

Practice location:
  • Phone: 630-655-3737
  • Fax:
Mailing address:
  • Phone: 630-655-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21-001141
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21-001083
License Number StateIL

VIII. Authorized Official

Name: DR. ANDREW W BROWAR
Title or Position: OWNER
Credential: DDS
Phone: 630-655-3737