Provider Demographics
NPI:1760725436
Name:PLUM GROVE FAMILY DENTAL
Entity Type:Organization
Organization Name:PLUM GROVE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-221-5860
Mailing Address - Street 1:2166 PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1932
Mailing Address - Country:US
Mailing Address - Phone:847-221-5860
Mailing Address - Fax:847-221-5861
Practice Address - Street 1:2166 PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1932
Practice Address - Country:US
Practice Address - Phone:847-221-5860
Practice Address - Fax:847-221-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190256561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty