Provider Demographics
NPI:1710579958
Name:ADVOCATE DENTAL GROUP LLC
Entity Type:Organization
Organization Name:ADVOCATE DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUBRAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-610-1041
Mailing Address - Street 1:610 CRYSTAL POINT DR STE 5
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1400
Mailing Address - Country:US
Mailing Address - Phone:773-610-1041
Mailing Address - Fax:
Practice Address - Street 1:610 CRYSTAL POINT DR STE 5
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1400
Practice Address - Country:US
Practice Address - Phone:773-610-1041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty