Provider Demographics
NPI:1609047349
Name:CHILDREN'S & ADOLESCENT DENTISTRY, LTD
Entity Type:Organization
Organization Name:CHILDREN'S & ADOLESCENT DENTISTRY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-299-1095
Mailing Address - Street 1:2401 RAVINE WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7645
Mailing Address - Country:US
Mailing Address - Phone:847-901-1095
Mailing Address - Fax:
Practice Address - Street 1:2401 RAVINE WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7645
Practice Address - Country:US
Practice Address - Phone:847-901-1095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S & ADOLESCENT DENTISTRY, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty