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General NPI Number Information
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NPI Number | 1700800356
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Entity Type | Organization
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Legal Business Name | NORTH CREEK DENTAL PC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 18425 W WEST CREEK DR SUITE I
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City | TINLEY PARK
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State | IL
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Zip | 60477-6767
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Country | US
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Telephone | 708-532-4131
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Fax | 708-532-4151
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Provider Business Mailing Address
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Address Line | 18425 W WEST CREEK DR SUITE I
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City | TINLEY PARK
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State | IL
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Zip | 60477-6767
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Country | US
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Telephone | 708-532-4131
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Fax | 708-532-4151
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Authorized Official
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Title or Position | OWNE NORTHECREEKDENTALCARE
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Name | MR. THOMAS JOSEPH RYAN JR.
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Credential | DDS
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Telephone | 708-532-4131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019023655
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License Number State | IL
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