Provider Demographics
NPI:1639397995
Name:ADVANCED PERIODONTICS
Entity Type:Organization
Organization Name:ADVANCED PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARDOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-255-3021
Mailing Address - Street 1:1420 N. ARLINGTON HTS. RD. #110
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS.
Mailing Address - State:IL
Mailing Address - Zip Code:60004
Mailing Address - Country:US
Mailing Address - Phone:847-255-3021
Mailing Address - Fax:
Practice Address - Street 1:1420 N. ARLINGTON HTS. RD. #110
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS.
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-255-3021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190159171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty