Provider Demographics
NPI:1063642874
Name:IVAN A VALCARENGHI DDS LTD PC
Entity Type:Organization
Organization Name:IVAN A VALCARENGHI DDS LTD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALCARENGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-834-8088
Mailing Address - Street 1:360 W BUTTERFIELD RD STE 230
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5000
Mailing Address - Country:US
Mailing Address - Phone:630-834-8088
Mailing Address - Fax:630-834-8091
Practice Address - Street 1:360 W BUTTERFIELD RD STE 230
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5000
Practice Address - Country:US
Practice Address - Phone:630-834-8088
Practice Address - Fax:630-834-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020242261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental