Provider Demographics
NPI:1568760247
Name:ILLINOIS MOBILE DENTISTRY PC
Entity Type:Organization
Organization Name:ILLINOIS MOBILE DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANU
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-451-4106
Mailing Address - Street 1:300 S MCLEAN BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-1023
Mailing Address - Country:US
Mailing Address - Phone:224-535-8515
Mailing Address - Fax:224-535-9366
Practice Address - Street 1:300 S MCLEAN BLVD STE M
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1023
Practice Address - Country:US
Practice Address - Phone:224-535-8515
Practice Address - Fax:224-535-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty