Provider Demographics
NPI:1003690496
Name:DYER DENTISTRY SERVICES
Entity Type:Organization
Organization Name:DYER DENTISTRY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-215-5876
Mailing Address - Street 1:1600 SAVANNAH CIR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1637
Mailing Address - Country:US
Mailing Address - Phone:319-215-5876
Mailing Address - Fax:
Practice Address - Street 1:20505 N RAND RD STE 244
Practice Address - Street 2:
Practice Address - City:KILDEER
Practice Address - State:IL
Practice Address - Zip Code:60047-3004
Practice Address - Country:US
Practice Address - Phone:847-796-0789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental