Provider Demographics
NPI:1598056780
Name:TOWN & COUNTRY DENTAL CARE, LTD.
Entity Type:Organization
Organization Name:TOWN & COUNTRY DENTAL CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-383-0330
Mailing Address - Street 1:1144 LAKE STREET
Mailing Address - Street 2:SUITE 213
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1043
Mailing Address - Country:US
Mailing Address - Phone:708-383-0330
Mailing Address - Fax:
Practice Address - Street 1:1144 LAKE STREET
Practice Address - Street 2:SUITE 213
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1043
Practice Address - Country:US
Practice Address - Phone:708-383-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019065261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental