Provider Demographics
NPI:1306211271
Name:OAK DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:OAK DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-422-1900
Mailing Address - Street 1:10232 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4602
Mailing Address - Country:US
Mailing Address - Phone:708-422-1900
Mailing Address - Fax:708-422-5281
Practice Address - Street 1:10232 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4602
Practice Address - Country:US
Practice Address - Phone:708-422-1900
Practice Address - Fax:708-422-5281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty