Provider Demographics
NPI:1295905131
Name:PALATINE DENTISTRY PC
Entity type:Organization
Organization Name:PALATINE DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMALOU
Authorized Official - Middle Name:VILLANUEVA
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-776-8043
Mailing Address - Street 1:855 E PALATINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-5500
Mailing Address - Country:US
Mailing Address - Phone:847-776-8043
Mailing Address - Fax:847-776-8061
Practice Address - Street 1:855 E PALATINE RD STE 100
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-5500
Practice Address - Country:US
Practice Address - Phone:847-776-8043
Practice Address - Fax:847-776-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty