Provider Demographics
NPI:1558402149
Name:FIRST DENTAL P.C.
Entity Type:Organization
Organization Name:FIRST DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PUSATERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-369-8000
Mailing Address - Street 1:8 W GARTNER RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7521
Mailing Address - Country:US
Mailing Address - Phone:630-369-8000
Mailing Address - Fax:630-369-9706
Practice Address - Street 1:8 W GARTNER RD
Practice Address - Street 2:SUITE 124
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7521
Practice Address - Country:US
Practice Address - Phone:630-369-8000
Practice Address - Fax:630-369-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty