Provider Demographics
NPI:1043097348
Name:HIGHLAND PARK ENDODONTICS
Entity Type:Organization
Organization Name:HIGHLAND PARK ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NELI
Authorized Official - Middle Name:
Authorized Official - Last Name:TUJAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-433-5155
Mailing Address - Street 1:600 CENTRAL AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5611
Mailing Address - Country:US
Mailing Address - Phone:847-433-5155
Mailing Address - Fax:
Practice Address - Street 1:600 CENTRAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5611
Practice Address - Country:US
Practice Address - Phone:847-433-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty