Provider Demographics
NPI:1508080110
Name:NORTHWESTERN DENTAL GROUP LTD
Entity Type:Organization
Organization Name:NORTHWESTERN DENTAL GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULVANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-945-3515
Mailing Address - Street 1:400 LAKE COOK RD STE 114
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4929
Mailing Address - Country:US
Mailing Address - Phone:847-945-3515
Mailing Address - Fax:
Practice Address - Street 1:7745 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4735
Practice Address - Country:US
Practice Address - Phone:847-967-6744
Practice Address - Fax:847-967-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty