Provider Demographics
NPI:1871826438
Name:ELMHURST DENTAL GROUP, LTD DBA BLOOMINGDALE DENTAL
Entity Type:Organization
Organization Name:ELMHURST DENTAL GROUP, LTD DBA BLOOMINGDALE DENTAL
Other - Org Name:BLOOMINGDALE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-833-5110
Mailing Address - Street 1:333 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2641
Mailing Address - Country:US
Mailing Address - Phone:630-833-5110
Mailing Address - Fax:630-833-0458
Practice Address - Street 1:290 SPRINGFIELD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2214
Practice Address - Country:US
Practice Address - Phone:630-529-0027
Practice Address - Fax:630-529-0068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELMHURST DENTAL GROUP, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-15
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty