Provider Demographics
NPI:1407905169
Name:SUMMERSET DENTAL CARE
Entity Type:Organization
Organization Name:SUMMERSET DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AGARWAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-747-1430
Mailing Address - Street 1:3612 LINCOLN HWY
Mailing Address - Street 2:SUITE 18
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1627
Mailing Address - Country:US
Mailing Address - Phone:708-747-1430
Mailing Address - Fax:708-747-9426
Practice Address - Street 1:3612 LINCOLN HWY
Practice Address - Street 2:SUITE 18
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1627
Practice Address - Country:US
Practice Address - Phone:708-747-1430
Practice Address - Fax:708-747-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty