Provider Demographics
NPI:1427224872
Name:ACDI ORLAND PARK LLC
Entity Type:Organization
Organization Name:ACDI ORLAND PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZUZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-586-9483
Mailing Address - Street 1:9641 W 153RD ST
Mailing Address - Street 2:SUITE #41
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3775
Mailing Address - Country:US
Mailing Address - Phone:708-873-9709
Mailing Address - Fax:708-873-1388
Practice Address - Street 1:9641 W 153RD ST
Practice Address - Street 2:SUITE #41
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3775
Practice Address - Country:US
Practice Address - Phone:708-873-9709
Practice Address - Fax:708-873-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190135831223G0001X
IL0190273111223G0001X
IL019.0277931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty