Provider Demographics
NPI:1033655584
Name:COMPASS DENTAL OF ROGERS PARK LLC
Entity Type:Organization
Organization Name:COMPASS DENTAL OF ROGERS PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-525-2011
Mailing Address - Street 1:2727 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3007
Mailing Address - Country:US
Mailing Address - Phone:773-262-4544
Mailing Address - Fax:
Practice Address - Street 1:2727 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3007
Practice Address - Country:US
Practice Address - Phone:773-262-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental