Provider Demographics
NPI:1275943516
Name:ABSOLUTE DENTAL CARE
Entity Type:Organization
Organization Name:ABSOLUTE DENTAL CARE
Other - Org Name:SAMIR BALANEY DDS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BALANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-383-2992
Mailing Address - Street 1:312 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4833
Mailing Address - Country:US
Mailing Address - Phone:708-383-2992
Mailing Address - Fax:708-383-4540
Practice Address - Street 1:312 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4833
Practice Address - Country:US
Practice Address - Phone:708-383-2992
Practice Address - Fax:708-383-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty