Provider Demographics
NPI:1366505570
Name:ASSOCIATED PERIODONTISTS,LTD.
Entity Type:Organization
Organization Name:ASSOCIATED PERIODONTISTS,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BUELTMANN
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-724-6343
Mailing Address - Street 1:1775 GLENVIEW RD
Mailing Address - Street 2:SUITE #212
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2956
Mailing Address - Country:US
Mailing Address - Phone:847-724-6343
Mailing Address - Fax:
Practice Address - Street 1:1775 GLENVIEW RD
Practice Address - Street 2:SUITE #212
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2956
Practice Address - Country:US
Practice Address - Phone:847-724-6343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21-S7531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty