Provider Demographics
NPI:1710085410
Name:R TAGE WELINDT JR DDS LTD
Entity Type:Organization
Organization Name:R TAGE WELINDT JR DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TAGE
Authorized Official - Last Name:WELINDT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-848-2853
Mailing Address - Street 1:1515 N HARLEM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1250
Mailing Address - Country:US
Mailing Address - Phone:708-848-2853
Mailing Address - Fax:708-848-1330
Practice Address - Street 1:1515 N HARLEM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1250
Practice Address - Country:US
Practice Address - Phone:708-848-2853
Practice Address - Fax:708-848-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty