Provider Demographics
NPI:1568671816
Name:ASSOCIATES FOR GENERAL DENTISTRY, LTD.
Entity Type:Organization
Organization Name:ASSOCIATES FOR GENERAL DENTISTRY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VALLELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-392-4422
Mailing Address - Street 1:1307 N RAND RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1307 N RAND RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4307
Practice Address - Country:US
Practice Address - Phone:847-392-4422
Practice Address - Fax:874-392-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019155681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty