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General NPI Number Information
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NPI Number | 1467462622
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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 | 08/09/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 195 ARLINGTON HTS RD ST 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 | 847-537-6758
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Provider Business Mailing Address
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Address Line | 195 ARLINGTON HTS RD ST 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 | 847-537-6758
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. FRED S MARGOLIS
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Credential | DDS
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Telephone | 847-537-1695
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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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Taxonomy #2
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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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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 |
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License Number State | IL
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