Provider Demographics
NPI:1144579905
Name:MINALT & WOJCICKI DENTAL GROUP LLC
Entity Type:Organization
Organization Name:MINALT & WOJCICKI DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINALT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-671-0700
Mailing Address - Street 1:1 TIFFANY PT
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2936
Mailing Address - Country:US
Mailing Address - Phone:630-671-0700
Mailing Address - Fax:
Practice Address - Street 1:1 TIFFANY PT
Practice Address - Street 2:SUITE 209
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2936
Practice Address - Country:US
Practice Address - Phone:630-671-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021250122300000X
IL019029179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty