Provider Demographics
NPI:1396917993
Name:CHILDREN'S & ADOLESCENT DENTISTRY, LTD
Entity type:Organization
Organization Name:CHILDREN'S & ADOLESCENT DENTISTRY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-885-1095
Mailing Address - Street 1:2500 W HIGGINS RD
Mailing Address - Street 2:SUITE 660
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7220
Mailing Address - Country:US
Mailing Address - Phone:847-885-1095
Mailing Address - Fax:
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:SUITE 660
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7220
Practice Address - Country:US
Practice Address - Phone:847-885-1095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S & ADOLESCENT DENTISTRY, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty