Provider Demographics
NPI:1023007234
Name:CARPENTERSVILLE DENTAL CARE, LTD.
Entity type:Organization
Organization Name:CARPENTERSVILLE DENTAL CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONGCHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-551-1199
Mailing Address - Street 1:150 S KENNEDY DR
Mailing Address - Street 2:SUITE 23 A
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-2091
Mailing Address - Country:US
Mailing Address - Phone:847-551-1199
Mailing Address - Fax:847-783-5282
Practice Address - Street 1:150 S KENNEDY DR
Practice Address - Street 2:SUITE 23 A
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-2091
Practice Address - Country:US
Practice Address - Phone:847-551-1199
Practice Address - Fax:847-783-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty