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General NPI Number Information
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NPI Number | 1396917993
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Entity Type | Organization
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Legal Business Name | CHILDREN'S & ADOLESCENT DENTISTRY, LTD
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 2500 W HIGGINS RD SUITE 660
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-7220
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Country | US
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Telephone | 847-885-1095
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 W HIGGINS RD SUITE 660
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-7220
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Country | US
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Telephone | 847-885-1095
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. LEO MORTON
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Credential | D.D.S.
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Telephone | 847-885-1095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | IL
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