Provider Demographics
NPI:1942653324
Name:NORTH AVE. DENTAL PARTNERS P.C.
Entity Type:Organization
Organization Name:NORTH AVE. DENTAL PARTNERS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:224-517-3474
Mailing Address - Street 1:26 WYCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6122
Mailing Address - Country:US
Mailing Address - Phone:224-517-3474
Mailing Address - Fax:
Practice Address - Street 1:7020 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4306
Practice Address - Country:US
Practice Address - Phone:773-745-8300
Practice Address - Fax:773-745-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190171171223G0001X
IL0190295951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1477744043OtherINDIVIDUAL NPI
IL1275897332OtherINDIVIDUAL NPI