Provider Demographics
NPI:1760601298
Name:NORTHBROOK COURT DENTAL ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:NORTHBROOK COURT DENTAL ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-272-2900
Mailing Address - Street 1:1535 LAKE COOK RD
Mailing Address - Street 2:SUITE 602
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1447
Mailing Address - Country:US
Mailing Address - Phone:847-272-2900
Mailing Address - Fax:847-272-3070
Practice Address - Street 1:1535 LAKE COOK RD
Practice Address - Street 2:SUITE 602
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1447
Practice Address - Country:US
Practice Address - Phone:847-272-2900
Practice Address - Fax:847-272-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty