Provider Demographics
NPI:1215212428
Name:PRISTINE FAMILY DENTISTRY LTD
Entity Type:Organization
Organization Name:PRISTINE FAMILY DENTISTRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALIPI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-248-8580
Mailing Address - Street 1:840 W IRVING PARK RD
Mailing Address - Street 2:SUITE407
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3011
Mailing Address - Country:US
Mailing Address - Phone:773-248-8580
Mailing Address - Fax:773-248-8581
Practice Address - Street 1:840 W IRVING PARK RD
Practice Address - Street 2:SUITE407
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3011
Practice Address - Country:US
Practice Address - Phone:773-248-8580
Practice Address - Fax:773-248-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026888122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty