Provider Demographics
NPI:1003232901
Name:ARCHER FAMILY DENTAL LTD
Entity Type:Organization
Organization Name:ARCHER FAMILY DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANETA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-586-0799
Mailing Address - Street 1:6615 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2407
Mailing Address - Country:US
Mailing Address - Phone:773-586-9700
Mailing Address - Fax:
Practice Address - Street 1:6615 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2407
Practice Address - Country:US
Practice Address - Phone:773-586-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190286581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty