Provider Demographics
NPI:1649421769
Name:NEW ENGLAND DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:NEW ENGLAND DENTAL GROUP, P.C.
Other - Org Name:BRIGHT DENTAL OF LOGAN SQUARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-276-9280
Mailing Address - Street 1:3300 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3718
Mailing Address - Country:US
Mailing Address - Phone:773-276-9280
Mailing Address - Fax:773-276-9281
Practice Address - Street 1:3300 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3718
Practice Address - Country:US
Practice Address - Phone:773-276-9280
Practice Address - Fax:773-276-9281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ENGLAND DENTAL GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190261451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty