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General NPI Number Information
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NPI Number | 1407446081
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL ASSOCIATES, PC
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 950 N. NORTHWEST HIGHWAY SUITE 102
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City | PARK RIDGE
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State | IL
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Zip | 60068
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Country | US
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Telephone | 847-861-7695
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Fax |
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Provider Business Mailing Address
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Address Line | 195 N. ARLINGTON HEIGHTS RD., SUITE 150
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City | BUFFALO GROVE
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State | IL
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Zip | 60089
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Country | US
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Telephone | 847-537-7695
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE LIN
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Credential | DDS
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Telephone | 847-537-7695
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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 |
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