Provider Demographics
NPI:1326112491
Name:SOUTH SCHAUMBURG DENTAL PROFESSIONALS LTD
Entity Type:Organization
Organization Name:SOUTH SCHAUMBURG DENTAL PROFESSIONALS LTD
Other - Org Name:HOFFMAN ESTATES DENTAL PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERUYUKI
Authorized Official - Middle Name:
Authorized Official - Last Name:HATAKEYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-884-0120
Mailing Address - Street 1:1585 N BARRINGTON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-884-0120
Mailing Address - Fax:847-884-0344
Practice Address - Street 1:1585 N BARRINGTON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-884-0120
Practice Address - Fax:847-884-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty