Provider Demographics
NPI:1376610659
Name:NEW AGE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:NEW AGE DENTAL ASSOCIATES
Other - Org Name:DR J DANIEL HOOBCHAAK OR DR K M JAREMUS DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOBCHAAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-438-3530
Mailing Address - Street 1:245 N RAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-438-3530
Mailing Address - Fax:847-438-3542
Practice Address - Street 1:245 N RAND RD
Practice Address - Street 2:NEW AGE DENTAL ASSOCIATES
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-438-3530
Practice Address - Fax:847-438-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty