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General NPI Number Information
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NPI Number | 1629379680
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Entity Type | Organization
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Legal Business Name | UNITED DENTAL CENTERS
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 18511 TORRENCE AVE SUITE 2B
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City | LANSING
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State | IL
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Zip | 60438-2851
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Country | US
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Telephone | 708-474-5055
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Fax |
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Provider Business Mailing Address
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Address Line | 18511 TORRENCE AVE SUITE 2B
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City | LANSING
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State | IL
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Zip | 60438-2851
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Country | US
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Telephone | 708-474-5055
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH FRIED
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Credential | DDS
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Telephone | 708-474-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019017190
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License Number State | IL
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