Provider Demographics
NPI:1952648990
Name:DR CARL L CHEEKS DDS PC
Entity Type:Organization
Organization Name:DR CARL L CHEEKS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-869-9708
Mailing Address - Street 1:1626 DARROW AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3418
Mailing Address - Country:US
Mailing Address - Phone:847-869-9708
Mailing Address - Fax:847-869-9715
Practice Address - Street 1:1626 DARROW AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3418
Practice Address - Country:US
Practice Address - Phone:847-869-9708
Practice Address - Fax:847-869-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190128371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12837Medicaid