Provider Demographics
NPI:1598834046
Name:HARLEM DENTAL LTD.
Entity Type:Organization
Organization Name:HARLEM DENTAL LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-749-1643
Mailing Address - Street 1:2911 S. HARLEM AVE.
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2827
Mailing Address - Country:US
Mailing Address - Phone:708-749-1643
Mailing Address - Fax:708-749-1797
Practice Address - Street 1:2911 S. HARLEM AVE.
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2827
Practice Address - Country:US
Practice Address - Phone:708-749-1643
Practice Address - Fax:708-749-1797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019 0163591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty