Provider Demographics
NPI:1326327354
Name:ALBERT AND ALBERT DENTAL HEALTH ASSOCIATED
Entity Type:Organization
Organization Name:ALBERT AND ALBERT DENTAL HEALTH ASSOCIATED
Other - Org Name:BRUSH PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-504-2223
Mailing Address - Street 1:911 N ELM ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3634
Mailing Address - Country:US
Mailing Address - Phone:630-504-2223
Mailing Address - Fax:630-504-2229
Practice Address - Street 1:911 N ELM ST
Practice Address - Street 2:SUITE 228
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3634
Practice Address - Country:US
Practice Address - Phone:630-504-2223
Practice Address - Fax:630-504-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210022071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty