Provider Demographics
NPI:1144567595
Name:PARK RIDGE PERIODONTICS, INC.
Entity Type:Organization
Organization Name:PARK RIDGE PERIODONTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:DIFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:847-318-0066
Mailing Address - Street 1:511 W TALCOTT RD
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5338
Mailing Address - Country:US
Mailing Address - Phone:847-318-0066
Mailing Address - Fax:847-318-9574
Practice Address - Street 1:511 W TALCOTT RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5338
Practice Address - Country:US
Practice Address - Phone:847-318-0066
Practice Address - Fax:847-318-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0011831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty