Provider Demographics
NPI:1114235892
Name:AESTHETIC DENTAL SOLUTIONS, P.C.
Entity Type:Organization
Organization Name:AESTHETIC DENTAL SOLUTIONS, P.C.
Other - Org Name:AMERICA'S BEST DENTAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:FUKUSHIMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-267-7645
Mailing Address - Street 1:2941 W ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2941 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4635
Practice Address - Country:US
Practice Address - Phone:773-267-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190257181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6061801Medicaid