Provider Demographics
NPI:1164181772
Name:HAMILTON LAKES DENTISTRY GROUP, PLLC
Entity Type:Organization
Organization Name:HAMILTON LAKES DENTISTRY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-773-6966
Mailing Address - Street 1:500 PARK BLVD STE 180C
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-3121
Mailing Address - Country:US
Mailing Address - Phone:630-773-6966
Mailing Address - Fax:
Practice Address - Street 1:500 PARK BLVD STE 180C
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-3121
Practice Address - Country:US
Practice Address - Phone:630-773-6966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1417000704OtherNATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM
IL1598147324OtherNATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM
IL1225385701OtherNATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM