Provider Demographics
NPI:1598927733
Name:QUINTESSENTIAL DENTAL
Entity Type:Organization
Organization Name:QUINTESSENTIAL DENTAL
Other - Org Name:HAPPY TOOTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:AUGUSTYN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-834-4140
Mailing Address - Street 1:132 N ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2864
Mailing Address - Country:US
Mailing Address - Phone:630-834-4140
Mailing Address - Fax:630-834-4577
Practice Address - Street 1:132 N ADDISON AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2864
Practice Address - Country:US
Practice Address - Phone:630-834-4140
Practice Address - Fax:630-834-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190263971223G0001X
IL0190252171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty