Provider Demographics
NPI:1336537588
Name:FAMILY&PEDIATRIC DENTAL, INC
Entity Type:Organization
Organization Name:FAMILY&PEDIATRIC DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBEID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-679-2419
Mailing Address - Street 1:8418 W CRAIN ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1845
Mailing Address - Country:US
Mailing Address - Phone:773-679-2419
Mailing Address - Fax:773-561-5517
Practice Address - Street 1:381 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2414
Practice Address - Country:US
Practice Address - Phone:773-679-2419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028238261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental