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General NPI Number Information
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NPI Number | 1407003437
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Entity Type | Organization
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Legal Business Name | TOTAL DENTISTRY
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 647 N 1ST BANK DR
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City | PALATINE
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State | IL
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Zip | 60067-8111
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Country | US
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Telephone | 847-358-2477
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Fax | 847-358-1217
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Provider Business Mailing Address
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Address Line | 647 N 1ST BANK DR
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City | PALATINE
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State | IL
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Zip | 60067-8111
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Country | US
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Telephone | 847-358-2477
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Fax | 847-358-1217
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Authorized Official
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Title or Position | CEO
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Name | DR. ANNA M PELAK
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Credential | DDS
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Telephone | 847-358-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 019020825
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 019020825
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 019020825
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019020825
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019020825
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License Number State | IL
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