=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760540223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINNETKA DENTAL ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 GREEN BAY RD
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60093-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-441-5660
-----------------------------------------------------
Fax | 847-441-5866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 GREEN BAY RD
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60093-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-441-5660
-----------------------------------------------------
Fax | 847-441-5866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JEFFREY SCOTT DREEBIN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 847-441-5660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------