Provider Demographics
NPI:1942793815
Name:MILLENNIUM DENTAL SPECIALIST
Entity Type:Organization
Organization Name:MILLENNIUM DENTAL SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:312-588-0112
Mailing Address - Street 1:1624 W DIVISION ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3908
Mailing Address - Country:US
Mailing Address - Phone:773-227-9000
Mailing Address - Fax:773-227-9009
Practice Address - Street 1:1624 W DIVISION ST STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3908
Practice Address - Country:US
Practice Address - Phone:773-227-9000
Practice Address - Fax:773-227-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190268711223E0200X
IL0190259001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty