Provider Demographics
NPI:1891030094
Name:AMERICAN DENTAL GROUP, INC
Entity Type:Organization
Organization Name:AMERICAN DENTAL GROUP, INC
Other - Org Name:SMILE MORE TODAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-247-1700
Mailing Address - Street 1:250 CENTER DR
Mailing Address - Street 2:STE 202
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1582
Mailing Address - Country:US
Mailing Address - Phone:847-247-1700
Mailing Address - Fax:847-810-0385
Practice Address - Street 1:250 CENTER DR
Practice Address - Street 2:STE 202
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1582
Practice Address - Country:US
Practice Address - Phone:847-247-1700
Practice Address - Fax:847-810-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental