Provider Demographics
NPI:1639237266
Name:YORKVILLE DENTAL
Entity Type:Organization
Organization Name:YORKVILLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-357-3333
Mailing Address - Street 1:624 W. VETERANS PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-0000
Mailing Address - Country:US
Mailing Address - Phone:630-553-8664
Mailing Address - Fax:630-553-8665
Practice Address - Street 1:624 W. VETERANS PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-0000
Practice Address - Country:US
Practice Address - Phone:630-553-8664
Practice Address - Fax:630-553-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty