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General NPI Number Information
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NPI Number | 1619412087
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Entity Type | Organization
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Legal Business Name | ARTISAN DENTAL GROUP OF ILLINOIS LLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 649 N 1ST BANK DR
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City | PALATINE
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State | IL
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Zip | 60067-8111
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Country | US
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Telephone | 847-934-4200
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Fax | 847-934-4294
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Provider Business Mailing Address
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Address Line | 649 N 1ST BANK DR
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City | PALATINE
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State | IL
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Zip | 60067-8111
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Country | US
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Telephone | 847-934-4200
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Fax | 847-934-4294
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Authorized Official
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Title or Position | PRESIDENT/CO-OWNER
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Name | DR. DONNA MADDALOZZO
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Credential | DDS, M.S.
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Telephone | 847-934-4280
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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 | 021001354
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 021001510
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019021223
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 021001430
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019019961
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019019847
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License Number State | IL
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