Provider Demographics
NPI:1275225609
Name:ADDISON SWIFT DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:ADDISON SWIFT DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREATHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-501-0065
Mailing Address - Street 1:140 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3504
Mailing Address - Country:US
Mailing Address - Phone:630-953-9999
Mailing Address - Fax:
Practice Address - Street 1:190 N SWIFT RD STE G
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1476
Practice Address - Country:US
Practice Address - Phone:630-627-7626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty