Provider Demographics
NPI:1619219177
Name:DENTISTS R US
Entity Type:Organization
Organization Name:DENTISTS R US
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:OATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-879-7755
Mailing Address - Street 1:100 SAUNDERS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2502
Mailing Address - Country:US
Mailing Address - Phone:847-574-6345
Mailing Address - Fax:847-574-6346
Practice Address - Street 1:100 SAUNDERS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2502
Practice Address - Country:US
Practice Address - Phone:847-574-6345
Practice Address - Fax:847-574-6346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029095122300000X
IL019.028536122300000X
IL019.021000122300000X
IL019.027578122300000X
IL019.026049122300000X
IL019.028449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty