Provider Demographics
NPI:1457473159
Name:DENTAL INNOVATIONS LTD
Entity Type:Organization
Organization Name:DENTAL INNOVATIONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-784-4554
Mailing Address - Street 1:4554 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2103
Mailing Address - Country:US
Mailing Address - Phone:773-784-4554
Mailing Address - Fax:773-784-4668
Practice Address - Street 1:4554 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2103
Practice Address - Country:US
Practice Address - Phone:773-784-4554
Practice Address - Fax:773-784-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty