Provider Demographics
NPI:1639479231
Name:AESTHETIC DENTAL LLC
Entity Type:Organization
Organization Name:AESTHETIC DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-893-1300
Mailing Address - Street 1:183 S BLOOMINGDALE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1466
Mailing Address - Country:US
Mailing Address - Phone:630-893-1300
Mailing Address - Fax:630-893-1319
Practice Address - Street 1:183 S BLOOMINGDALE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1466
Practice Address - Country:US
Practice Address - Phone:630-893-1300
Practice Address - Fax:630-893-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty