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General NPI Number Information
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NPI Number | 1568709988
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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 | 01/04/2013
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 690 N IL ROUTE 31 SUITE D
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City | CRYSTAL LAKE
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State | IL
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Zip | 60012-3790
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Country | US
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Telephone | 815-459-2727
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Fax | 815-479-5723
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Provider Business Mailing Address
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Address Line | 690 N IL ROUTE 31 SUITE D
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City | CRYSTAL LAKE
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State | IL
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Zip | 60012-3790
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Country | US
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Telephone | 815-459-2727
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Fax | 815-479-5723
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Authorized Official
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Title or Position | PEDIATRIC DENTAL
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Name | DR. GEORGE LIN
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Credential | DDS
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Telephone | 815-459-2727
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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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