Provider Demographics
NPI:1447573613
Name:AURORA MODERN DENTAL LLC
Entity Type:Organization
Organization Name:AURORA MODERN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-532-4902
Mailing Address - Street 1:808 N ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4912
Mailing Address - Country:US
Mailing Address - Phone:630-692-0500
Mailing Address - Fax:630-806-8082
Practice Address - Street 1:808 N ROUTE 59
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4912
Practice Address - Country:US
Practice Address - Phone:630-692-0500
Practice Address - Fax:630-806-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty