Provider Demographics
NPI:1568550192
Name:LINDENHURST DENTAL HEALTH GROUP
Entity Type:Organization
Organization Name:LINDENHURST DENTAL HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HENDRICKX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-356-0260
Mailing Address - Street 1:1909 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7960
Mailing Address - Country:US
Mailing Address - Phone:847-356-0260
Mailing Address - Fax:847-265-0365
Practice Address - Street 1:1909 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-7960
Practice Address - Country:US
Practice Address - Phone:847-356-0260
Practice Address - Fax:847-265-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty