Provider Demographics
NPI:1992838551
Name:PEARLY WHITES DENTAL INC
Entity Type:Organization
Organization Name:PEARLY WHITES DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYROSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCHIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-486-5264
Mailing Address - Street 1:810 N WOLCOTT AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7555
Mailing Address - Country:US
Mailing Address - Phone:773-486-5264
Mailing Address - Fax:773-486-5264
Practice Address - Street 1:810 N WOLCOTT AVE
Practice Address - Street 2:UNIT C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7555
Practice Address - Country:US
Practice Address - Phone:773-486-5264
Practice Address - Fax:773-486-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190262791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty