Provider Demographics
NPI:1417140534
Name:IMHOF, PAUL C
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:IMHOF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2206
Mailing Address - Country:US
Mailing Address - Phone:847-299-4811
Mailing Address - Fax:847-299-4379
Practice Address - Street 1:1645 S RIVER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2206
Practice Address - Country:US
Practice Address - Phone:847-299-4811
Practice Address - Fax:847-299-4379
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice