Provider Demographics
NPI:1285016709
Name:OAK MILL FAMILY DENTAL
Entity Type:Organization
Organization Name:OAK MILL FAMILY DENTAL
Other - Org Name:NILES FAMILY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTAL
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:ANAST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-965-4300
Mailing Address - Street 1:7900 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 2-30A
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3159
Mailing Address - Country:US
Mailing Address - Phone:847-965-4300
Mailing Address - Fax:866-830-0746
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 2-30A
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-965-4300
Practice Address - Fax:866-830-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1700031127OtherINDIVIDUAL NPI