Provider Demographics
NPI:1710091574
Name:AFFILIATED DENTAL SPECIALISTS LTD
Entity Type:Organization
Organization Name:AFFILIATED DENTAL SPECIALISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICES PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ORBON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-367-6055
Mailing Address - Street 1:1 E PHILLIP RD
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1858
Mailing Address - Country:US
Mailing Address - Phone:847-367-6055
Mailing Address - Fax:847-367-6079
Practice Address - Street 1:1 E PHILLIP RD
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1858
Practice Address - Country:US
Practice Address - Phone:847-367-6055
Practice Address - Fax:847-367-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty