MEDICARE: ASSOCIATES FOR GENERAL DENTISTRY, 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
1	1223G0001X	General Practice Dentistry	01915568	IL

General Provider Information

NPI Number	:	1568671816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES FOR GENERAL DENTISTRY, LTD.

Provider Business Mailing Address
First Line	:	1307 N RAND RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 N RAND RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4307
Country	:	US
Telephone Number	:	847-392-4422
Fax Number	:	874-392-4543

Authorized Official
Title or Position	:	CEO
Name	:	DR. H. EDWARD VALLELY
Credential	:	D.D.S.
Telephone Number	:	847-392-4422

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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