Provider Demographics
NPI:1679646962
Name:ADVANTAGE DENTAL CARE, LLC
Entity Type:Organization
Organization Name:ADVANTAGE DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-772-8001
Mailing Address - Street 1:7300 N WESTERN AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1857
Mailing Address - Country:US
Mailing Address - Phone:773-338-8433
Mailing Address - Fax:773-338-8434
Practice Address - Street 1:7300 N WESTERN AVE
Practice Address - Street 2:SUITE J
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1857
Practice Address - Country:US
Practice Address - Phone:773-338-8433
Practice Address - Fax:773-338-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBC7495662OtherDEA
IL=========OtherFEDERAL TIN