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General NPI Number Information
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NPI Number | 1417757915
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL DENTAL SPECIALTIES
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 20635 ABBEY WOODS CT N STE 203
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City | FRANKFORT
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State | IL
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Zip | 60423-3186
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Country | US
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Telephone | 815-464-3001
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Fax |
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Provider Business Mailing Address
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Address Line | 17236 MUNSTER LN
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City | TINLEY PARK
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State | IL
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Zip | 60477-4608
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Country | US
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Telephone | 319-389-7177
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMANDA PICHE
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Credential | DDS
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Telephone | 319-389-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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