Provider Demographics
NPI:1073688172
Name:EXCELLENT DENTISTRY LTD INC
Entity Type:Organization
Organization Name:EXCELLENT DENTISTRY LTD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EYBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-663-0300
Mailing Address - Street 1:5301 W DEMPSTER
Mailing Address - Street 2:STE 210
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-663-0300
Mailing Address - Fax:847-663-0332
Practice Address - Street 1:5301 W DEMPSTER
Practice Address - Street 2:STE 210
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-663-0300
Practice Address - Fax:847-663-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1001786Medicaid