Provider Demographics
NPI:1235267469
Name:NORTHWEST PERIODONTICS & IMPLANTS
Entity Type:Organization
Organization Name:NORTHWEST PERIODONTICS & IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEFFIELD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:847-358-3939
Mailing Address - Street 1:220 N SMITH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2488
Mailing Address - Country:US
Mailing Address - Phone:847-358-3939
Mailing Address - Fax:847-358-1462
Practice Address - Street 1:220 N SMITH ST STE 125
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2488
Practice Address - Country:US
Practice Address - Phone:847-358-3939
Practice Address - Fax:847-358-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600004221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty