Provider Demographics
NPI:1093063893
Name:DENTAL GROUP OF CHICAGO, INC
Entity Type:Organization
Organization Name:DENTAL GROUP OF CHICAGO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:UHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-588-0043
Mailing Address - Street 1:1556 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1937
Mailing Address - Country:US
Mailing Address - Phone:312-588-0043
Mailing Address - Fax:312-588-0287
Practice Address - Street 1:1556 S MICHIGAN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1937
Practice Address - Country:US
Practice Address - Phone:312-588-0043
Practice Address - Fax:312-588-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0194801223G0001X
IL021.0013971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty