Provider Demographics
NPI:1902818560
Name:CD&L DENTAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CD&L DENTAL ASSOCIATES, INC.
Other - Org Name:CD&L DENTAL ASSOCIATES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MHA
Authorized Official - Phone:847-587-6600
Mailing Address - Street 1:1250 S US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1950
Mailing Address - Country:US
Mailing Address - Phone:847-587-6600
Mailing Address - Fax:847-587-6618
Practice Address - Street 1:1250 S US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1950
Practice Address - Country:US
Practice Address - Phone:847-587-6600
Practice Address - Fax:847-587-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty