Provider Demographics
NPI:1245471291
Name:NORTHWEST DENTISTRY
Entity type:Organization
Organization Name:NORTHWEST DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAO
Authorized Official - Middle Name:HOAI
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-631-6677
Mailing Address - Street 1:6676 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1306
Mailing Address - Country:US
Mailing Address - Phone:773-631-6677
Mailing Address - Fax:773-631-6679
Practice Address - Street 1:6676 N NORTHWEST HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1306
Practice Address - Country:US
Practice Address - Phone:773-631-6677
Practice Address - Fax:773-631-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190262861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty