Provider Demographics
NPI:1598390577
Name:PARTRIDGE DENTAL, PROF. CORP.
Entity Type:Organization
Organization Name:PARTRIDGE DENTAL, PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PARTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-635-6268
Mailing Address - Street 1:690 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-9110
Mailing Address - Country:US
Mailing Address - Phone:847-635-6268
Mailing Address - Fax:847-635-5598
Practice Address - Street 1:690 1ST AVE
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-9110
Practice Address - Country:US
Practice Address - Phone:847-635-6268
Practice Address - Fax:847-635-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental