Provider Demographics
NPI:1629215199
Name:APEX DENTAL STUDIO
Entity Type:Organization
Organization Name:APEX DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-464-1200
Mailing Address - Street 1:346 N LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2008
Mailing Address - Country:US
Mailing Address - Phone:815-464-1200
Mailing Address - Fax:815-464-1291
Practice Address - Street 1:346 N LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2008
Practice Address - Country:US
Practice Address - Phone:815-464-1200
Practice Address - Fax:815-464-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty