Provider Demographics
NPI:1710653225
Name:DENTAL PROFESSIONALS OF OLD ORCHARD LTD
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF OLD ORCHARD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-519-2873
Mailing Address - Street 1:4905 OLD ORCHARD CTR STE 728
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4734
Mailing Address - Country:US
Mailing Address - Phone:847-676-1432
Mailing Address - Fax:
Practice Address - Street 1:4905 OLD ORCHARD CTR STE 728
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4734
Practice Address - Country:US
Practice Address - Phone:847-676-1432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental