Provider Demographics
NPI:1821240169
Name:TONGUE N CHIC DENTAL BOUTIQUE
Entity Type:Organization
Organization Name:TONGUE N CHIC DENTAL BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:FARLEY
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-841-6665
Mailing Address - Street 1:14 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-5546
Mailing Address - Country:US
Mailing Address - Phone:847-841-6665
Mailing Address - Fax:847-841-6656
Practice Address - Street 1:14 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5546
Practice Address - Country:US
Practice Address - Phone:847-841-6665
Practice Address - Fax:847-841-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty