Provider Demographics
NPI:1598814154
Name:KIDS PLUS PEDIATRIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:KIDS PLUS PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-772-7373
Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-772-7373
Mailing Address - Fax:773-772-5667
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 130
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-772-7373
Practice Address - Fax:773-772-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty