Provider Demographics
NPI:1164275111
Name:CHICAGO DENTAL ESTHETICS OF GLENVIEW
Entity Type:Organization
Organization Name:CHICAGO DENTAL ESTHETICS OF GLENVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RABOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-677-1119
Mailing Address - Street 1:450 GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3281
Mailing Address - Country:US
Mailing Address - Phone:847-677-1119
Mailing Address - Fax:
Practice Address - Street 1:450 GLENVIEW RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3281
Practice Address - Country:US
Practice Address - Phone:847-677-1119
Practice Address - Fax:847-677-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental