=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457632937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHARRINGTON FAMILY DENTAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2011
-----------------------------------------------------
Last Update Date | 08/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 EXECUTIVE CT SUITE #3
-----------------------------------------------------
City | SOUTH BARRINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60010-9534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-382-8889
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 EXECUTIVE CT SUITE #3
-----------------------------------------------------
City | SOUTH BARRINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60010-9534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-382-8889
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL B CHIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 847-382-8889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019021152
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------