Provider Demographics
NPI:1922347566
Name:CHAD C. DROUIN, D.M.D., P.C.
Entity Type:Organization
Organization Name:CHAD C. DROUIN, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DROUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-858-5755
Mailing Address - Street 1:493 DUANE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4501
Mailing Address - Country:US
Mailing Address - Phone:630-858-5755
Mailing Address - Fax:630-858-5760
Practice Address - Street 1:493 DUANE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4501
Practice Address - Country:US
Practice Address - Phone:630-858-5755
Practice Address - Fax:630-858-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0274161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019.027416OtherDENTAL LICENSE NUMBER