Provider Demographics
NPI:1457522591
Name:PERFORMANCE DENTAL CARE
Entity Type:Organization
Organization Name:PERFORMANCE DENTAL CARE
Other - Org Name:7-7 DENTAL OF FLOSSMOOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-599-8400
Mailing Address - Street 1:19509 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2097
Mailing Address - Country:US
Mailing Address - Phone:708-798-8787
Mailing Address - Fax:
Practice Address - Street 1:19509 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2097
Practice Address - Country:US
Practice Address - Phone:708-798-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty