Provider Demographics
NPI:1669839593
Name:ALGONQUIN KIDS DENTISTRY, INC
Entity Type:Organization
Organization Name:ALGONQUIN KIDS DENTISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:URSITTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:224-654-6543
Mailing Address - Street 1:4097 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9401
Mailing Address - Country:US
Mailing Address - Phone:224-654-6543
Mailing Address - Fax:
Practice Address - Street 1:4097 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9401
Practice Address - Country:US
Practice Address - Phone:224-654-6543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL ABOUT KIDS DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-22
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0017771223P0221X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty