Provider Demographics
NPI:1598937377
Name:A K A DENTAL
Entity Type:Organization
Organization Name:A K A DENTAL
Other - Org Name:DENTAL PROFILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RONCEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-516-0000
Mailing Address - Street 1:4445 N PULASKI RD STE R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4444
Mailing Address - Country:US
Mailing Address - Phone:773-279-9977
Mailing Address - Fax:773-279-8402
Practice Address - Street 1:4445 N PULASKI RD STE R
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4444
Practice Address - Country:US
Practice Address - Phone:773-279-9977
Practice Address - Fax:773-279-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty