Provider Demographics
NPI:1164730222
Name:ANDREW DENTAL CARE, LTD
Entity Type:Organization
Organization Name:ANDREW DENTAL CARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-429-1110
Mailing Address - Street 1:11950 S HARLEM AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1150
Mailing Address - Country:US
Mailing Address - Phone:708-429-1110
Mailing Address - Fax:
Practice Address - Street 1:11950 S HARLEM AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1150
Practice Address - Country:US
Practice Address - Phone:708-429-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREW DENTAL CARE, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0190022202OtherDENTIST