Provider Demographics
NPI:1629379680
Name:UNITED DENTAL CENTERS
Entity Type:Organization
Organization Name:UNITED DENTAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-474-5055
Mailing Address - Street 1:18511 TORRENCE AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2851
Mailing Address - Country:US
Mailing Address - Phone:708-474-5055
Mailing Address - Fax:
Practice Address - Street 1:18511 TORRENCE AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2851
Practice Address - Country:US
Practice Address - Phone:708-474-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty