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NPI Code Detail

MEDICARE: DCP OF ILLINOIS (VERNON HILLS), LTD

MEDICARE: DCP OF ILLINOIS (VERNON HILLS), LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist
21223E0200XEndodontics
31223P0221XPediatric Dentistry
41223P0300XPeriodontics
51223P0700XProsthodontics
61223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
71223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1144476375
Entity Type Code : Organization
Provider Name (Legal Business Name) : DCP OF ILLINOIS (VERNON HILLS), LTD
Provider Business Mailing Address
First Line : 7160 DALLAS PKWY STE 400
Second Line :
City : PLANO
State : TX
Zip : 75024-7111
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 555 E TOWNLINE RD
Second Line : #4
City : VERNON HILLS
State : IL
Zip : 60061-1552
Country : US
Telephone Number : 847-367-7119
Fax Number : 216-584-1068
Authorized Official
Title or Position : MANAGER, CREDENTIALING
Name : RACHEL NITTINGER
Credential :
Telephone Number : 972-755-0816
Provider Enumeration Date : 08/07/2008
Last Update Date : 03/20/2018

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Directions to “DCP OF ILLINOIS (VERNON HILLS), LTD ” Practice Location

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