Provider Demographics
NPI:1184826935
Name:ELITE DENTAL LTD
Entity Type:Organization
Organization Name:ELITE DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-348-6600
Mailing Address - Street 1:4142 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2007
Mailing Address - Country:US
Mailing Address - Phone:773-348-6600
Mailing Address - Fax:773-975-6245
Practice Address - Street 1:4142 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2007
Practice Address - Country:US
Practice Address - Phone:773-348-6600
Practice Address - Fax:773-975-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty