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NPI Code Detail

MEDICARE: ELITE DENTAL LTD

MEDICARE: ELITE DENTAL 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
1122300000XDentistIL

General Provider Information

NPI Number : 1184826935
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE DENTAL LTD
Provider Business Mailing Address
First Line : 4142 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2007
Country : US
Telephone Number : 773-348-6600
Fax Number : 773-975-6245
Provider Business Practice Location Address
First Line : 4142 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2007
Country : US
Telephone Number : 773-348-6600
Fax Number : 773-975-6245
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. BARBARA ANN FALCON
Credential :
Telephone Number : 773-348-6600
Provider Enumeration Date : 06/04/2007
Last Update Date : 08/22/2020

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Directions to “ELITE DENTAL LTD ” Practice Location

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