Provider Demographics
NPI:1821301102
Name:D2 DENTAL OF ILLINOIS, P.C.
Entity Type:Organization
Organization Name:D2 DENTAL OF ILLINOIS, P.C.
Other - Org Name:DESTINY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-369-5428
Mailing Address - Street 1:137 N OAK PARK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 E 87TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6246
Practice Address - Country:US
Practice Address - Phone:708-386-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty