Provider Demographics
NPI:1083773972
Name:DAVID A. KANAREK, DDS, PC.
Entity Type:Organization
Organization Name:DAVID A. KANAREK, DDS, PC.
Other - Org Name:OLD ORCHARD DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KANAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-677-5600
Mailing Address - Street 1:64 OLD ORCHARD SHOPPING CTR
Mailing Address - Street 2:SUITE 512
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1425
Mailing Address - Country:US
Mailing Address - Phone:847-677-5600
Mailing Address - Fax:847-674-5225
Practice Address - Street 1:64 OLD ORCHARD SHOPPING CTR
Practice Address - Street 2:SUITE 512
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1425
Practice Address - Country:US
Practice Address - Phone:847-677-5600
Practice Address - Fax:847-674-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190148841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty