Provider Demographics
NPI:1518280759
Name:PRECISION DENTAL CARE 2, LLC
Entity Type:Organization
Organization Name:PRECISION DENTAL CARE 2, LLC
Other - Org Name:PRECISION DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-283-2100
Mailing Address - Street 1:4830 N PULASKI RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2847
Mailing Address - Country:US
Mailing Address - Phone:773-283-2100
Mailing Address - Fax:773-283-2500
Practice Address - Street 1:4830 N PULASKI RD STE 108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2847
Practice Address - Country:US
Practice Address - Phone:773-283-2100
Practice Address - Fax:773-283-2500
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 Licenses
StateLicense IDTaxonomies
IL019026820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty