Provider Demographics
NPI:1659487544
Name:PADLECKAS, EDMUND VAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:VAL
Last Name:PADLECKAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 W FULLERTON AVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2458
Mailing Address - Country:US
Mailing Address - Phone:773-975-9606
Mailing Address - Fax:
Practice Address - Street 1:990 W FULLERTON AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2458
Practice Address - Country:US
Practice Address - Phone:773-975-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T38597Medicare UPIN
IL757470Medicare ID - Type Unspecified