Provider Demographics
NPI:1073897211
Name:DENTAL CARE OF ALGONQUIN
Entity Type:Organization
Organization Name:DENTAL CARE OF ALGONQUIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-658-3400
Mailing Address - Street 1:285 STONEGATE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5614
Mailing Address - Country:US
Mailing Address - Phone:847-658-3400
Mailing Address - Fax:847-658-3424
Practice Address - Street 1:285 STONEGATE RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5614
Practice Address - Country:US
Practice Address - Phone:847-658-3400
Practice Address - Fax:847-658-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017893332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment