Provider Demographics
NPI:1548430929
Name:TOTAL DENTAL CENTER INC.
Entity Type:Organization
Organization Name:TOTAL DENTAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:V
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-919-5757
Mailing Address - Street 1:3342 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3310
Mailing Address - Country:US
Mailing Address - Phone:773-463-5757
Mailing Address - Fax:773-463-2211
Practice Address - Street 1:3342 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3310
Practice Address - Country:US
Practice Address - Phone:773-463-5757
Practice Address - Fax:773-463-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty