Provider Demographics
NPI:1306399316
Name:DENTAL LOGIC, PC
Entity Type:Organization
Organization Name:DENTAL LOGIC, PC
Other - Org Name:HICKS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALNOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-359-9100
Mailing Address - Street 1:2381 N HICKS RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-1806
Mailing Address - Country:US
Mailing Address - Phone:847-359-9100
Mailing Address - Fax:847-359-9200
Practice Address - Street 1:2381 N HICKS RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-1806
Practice Address - Country:US
Practice Address - Phone:847-359-9100
Practice Address - Fax:847-359-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty