Provider Demographics
NPI:1710411178
Name:COMPASSIONATE DENTALCARE LLC
Entity Type:Organization
Organization Name:COMPASSIONATE DENTALCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:STIRNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-854-7645
Mailing Address - Street 1:261 N RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5999
Mailing Address - Country:US
Mailing Address - Phone:847-854-7645
Mailing Address - Fax:847-854-9373
Practice Address - Street 1:261 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5999
Practice Address - Country:US
Practice Address - Phone:847-854-7645
Practice Address - Fax:847-854-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190202741223G0001X
IL190172651223G0001X
IL190295841223G0001X
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty