Provider Demographics
NPI:1689708398
Name:OAK VIEW DENTAL GROUP, LTD.
Entity Type:Organization
Organization Name:OAK VIEW DENTAL GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-687-4280
Mailing Address - Street 1:5950 159TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3164
Mailing Address - Country:US
Mailing Address - Phone:708-687-4280
Mailing Address - Fax:708-687-2958
Practice Address - Street 1:5950 159TH ST
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3164
Practice Address - Country:US
Practice Address - Phone:708-687-4280
Practice Address - Fax:708-687-2958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1609903723Medicare UPIN
IL1356478481Medicare UPIN
IL1861529521Medicare UPIN