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General NPI Number Information
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NPI Number | 1518015726
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Entity Type | Organization
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Legal Business Name | SP DENTAL CARE, LTD.
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Dates
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Enumeration Date | 01/07/2007
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 1401 MCHENRY RD SUITE 224
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1382
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Country | US
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Telephone | 847-821-8890
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Fax | 847-821-8875
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Provider Business Mailing Address
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Address Line | 1401 MCHENRY RD SUITE 224
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1382
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Country | US
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Telephone | 847-821-8890
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Fax | 847-821-8875
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVE K PAEK
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Credential | D.D.S.
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Telephone | 847-821-8890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019-023569
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License Number State | IL
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