Provider Demographics
NPI:1417225194
Name:UNITED DENTAL CENTERS
Entity Type:Organization
Organization Name:UNITED DENTAL CENTERS
Other - Org Name:UNITED DENTAL CENTERS, LTD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-758-0002
Mailing Address - Street 1:1204 BALLYBUNION CT
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1268
Mailing Address - Country:US
Mailing Address - Phone:773-758-0002
Mailing Address - Fax:
Practice Address - Street 1:1204 BALLYBUNION CT
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1268
Practice Address - Country:US
Practice Address - Phone:773-758-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190171901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty