Provider Demographics
NPI:1992863500
Name:PEDIATRIC DENTAL SPECIALTY ASSOCIATES LTD
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL SPECIALTY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENEARND
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALGENIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-462-3030
Mailing Address - Street 1:315 ALANA DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1766
Mailing Address - Country:US
Mailing Address - Phone:815-462-3030
Mailing Address - Fax:815-462-4742
Practice Address - Street 1:315 ALANA DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1766
Practice Address - Country:US
Practice Address - Phone:815-462-3030
Practice Address - Fax:815-462-4742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty