Provider Demographics
NPI:1790190882
Name:WEBSTER DENTAL CARE OF MUNDELEIN, LTD.
Entity Type:Organization
Organization Name:WEBSTER DENTAL CARE OF MUNDELEIN, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-566-5100
Mailing Address - Street 1:444 PROSPECT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1963
Mailing Address - Country:US
Mailing Address - Phone:847-566-5100
Mailing Address - Fax:847-566-5160
Practice Address - Street 1:444 PROSPECT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1963
Practice Address - Country:US
Practice Address - Phone:847-566-5100
Practice Address - Fax:847-566-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019156311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty