Provider Demographics
NPI:1598985046
Name:BEHLES FAMILY DENTAL CARE, LLC
Entity Type:Organization
Organization Name:BEHLES FAMILY DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-328-8990
Mailing Address - Street 1:500 DAVIS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4668
Mailing Address - Country:US
Mailing Address - Phone:847-328-8990
Mailing Address - Fax:847-328-9075
Practice Address - Street 1:500 DAVIS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4668
Practice Address - Country:US
Practice Address - Phone:847-328-8990
Practice Address - Fax:847-328-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0195561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty