Provider Demographics
NPI:1457637266
Name:DENTISPC
Entity Type:Organization
Organization Name:DENTISPC
Other - Org Name:NORTHWESTPOINT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-647-1022
Mailing Address - Street 1:6400 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1877
Mailing Address - Country:US
Mailing Address - Phone:773-647-1022
Mailing Address - Fax:773-647-1106
Practice Address - Street 1:6400 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1877
Practice Address - Country:US
Practice Address - Phone:773-647-1022
Practice Address - Fax:773-647-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty