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General NPI Number Information
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NPI Number | 1275943516
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Entity Type | Organization
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Legal Business Name | ABSOLUTE DENTAL CARE
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 312 MADISON ST
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City | OAK PARK
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State | IL
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Zip | 60302-4833
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Country | US
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Telephone | 708-383-2992
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Fax | 708-383-4540
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Provider Business Mailing Address
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Address Line | 312 MADISON ST
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City | OAK PARK
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State | IL
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Zip | 60302-4833
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Country | US
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Telephone | 708-383-2992
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Fax | 708-383-4540
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SAMIR BALANEY
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Credential | DDS
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Telephone | 708-383-2992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028291
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License Number State | IL
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