Provider Demographics
NPI:1245435239
Name:ASSOCIATES FOR FAMILY DENTISTRY CHICAGO LTD
Entity type:Organization
Organization Name:ASSOCIATES FOR FAMILY DENTISTRY CHICAGO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WODNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-893-8636
Mailing Address - Street 1:183 S BLOOMINGDALE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1466
Mailing Address - Country:US
Mailing Address - Phone:630-893-8636
Mailing Address - Fax:630-893-4962
Practice Address - Street 1:183 S BLOOMINGDALE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1466
Practice Address - Country:US
Practice Address - Phone:630-893-8636
Practice Address - Fax:630-893-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty