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General NPI Number Information
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NPI Number | 1710653225
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS OF OLD ORCHARD LTD
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 4905 OLD ORCHARD CTR STE 728
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City | SKOKIE
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State | IL
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Zip | 60077-4734
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Country | US
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Telephone | 847-676-1432
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 OLD ORCHARD CTR STE 728
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City | SKOKIE
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State | IL
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Zip | 60077-4734
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Country | US
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Telephone | 847-676-1432
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID SCHWARTZ
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Credential | DDS
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Telephone | 847-519-2873
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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