Provider Demographics
NPI:1013982933
Name:.COLLEGE DRIVE DENTAL ASSOCIATES, LTD
Entity Type:Organization
Organization Name:.COLLEGE DRIVE DENTAL ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:UHRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-361-4626
Mailing Address - Street 1:7550 W COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1026
Mailing Address - Country:US
Mailing Address - Phone:708-361-4626
Mailing Address - Fax:
Practice Address - Street 1:7550 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1026
Practice Address - Country:US
Practice Address - Phone:708-361-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty