Provider Demographics
NPI:1952069106
Name:BA DENTAL CARE
Entity Type:Organization
Organization Name:BA DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-303-4858
Mailing Address - Street 1:1574 BELL SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61016
Mailing Address - Country:US
Mailing Address - Phone:815-229-1110
Mailing Address - Fax:
Practice Address - Street 1:1574 BELL SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61016
Practice Address - Country:US
Practice Address - Phone:815-229-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty