Provider Demographics
NPI:1851441158
Name:BUFFALO GROVE DENTAL CARE
Entity Type:Organization
Organization Name:BUFFALO GROVE DENTAL CARE
Other - Org Name:ADDISON FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-634-6575
Mailing Address - Street 1:1161 MCHENRY RD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1373
Mailing Address - Country:US
Mailing Address - Phone:847-634-6575
Mailing Address - Fax:847-634-6578
Practice Address - Street 1:1161 MCHENRY RD
Practice Address - Street 2:SUITE #201
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1373
Practice Address - Country:US
Practice Address - Phone:847-634-6575
Practice Address - Fax:847-634-6578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty