Provider Demographics
NPI:1639508641
Name:ARDEN DENTAL, P.C.
Entity Type:Organization
Organization Name:ARDEN DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WEN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-371-9779
Mailing Address - Street 1:PO BOX 3282
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-3282
Mailing Address - Country:US
Mailing Address - Phone:312-371-9779
Mailing Address - Fax:
Practice Address - Street 1:303 E ARMY TRAIL RD STE 421
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2155
Practice Address - Country:US
Practice Address - Phone:630-529-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190253661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty