Provider Demographics
NPI:1790174738
Name:EVANSTON DENTAL ASSOCIATES LTD.
Entity Type:Organization
Organization Name:EVANSTON DENTAL ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:SILBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-864-2243
Mailing Address - Street 1:500 DAVIS ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4668
Mailing Address - Country:US
Mailing Address - Phone:847-864-2243
Mailing Address - Fax:847-864-2270
Practice Address - Street 1:500 DAVIS ST
Practice Address - Street 2:SUITE 510
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4668
Practice Address - Country:US
Practice Address - Phone:847-864-2243
Practice Address - Fax:847-864-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-020446261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental