Provider Demographics
NPI:1073900460
Name:EXCELCARE DENTAL LLC
Entity Type:Organization
Organization Name:EXCELCARE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-548-2222
Mailing Address - Street 1:1227 N STATE ROUTE 83
Mailing Address - Street 2:E
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7932
Mailing Address - Country:US
Mailing Address - Phone:847-548-2222
Mailing Address - Fax:847-548-2223
Practice Address - Street 1:1227 N STATE ROUTE 83
Practice Address - Street 2:E
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7932
Practice Address - Country:US
Practice Address - Phone:847-548-2222
Practice Address - Fax:847-548-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190257151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty