Provider Demographics
NPI:1699028167
Name:COSMETIC AND IMPLANT DENTAL CENTER
Entity Type:Organization
Organization Name:COSMETIC AND IMPLANT DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:SILVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-675-7010
Mailing Address - Street 1:6921 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2605
Mailing Address - Country:US
Mailing Address - Phone:847-675-7010
Mailing Address - Fax:847-675-7716
Practice Address - Street 1:6921 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2605
Practice Address - Country:US
Practice Address - Phone:847-675-7010
Practice Address - Fax:847-675-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190171091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty