Provider Demographics
NPI:1457558058
Name:WHEATON DENTAL CENTER, LTD
Entity Type:Organization
Organization Name:WHEATON DENTAL CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:V
Authorized Official - Last Name:PADLECKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-668-0100
Mailing Address - Street 1:101 E COLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3105
Mailing Address - Country:US
Mailing Address - Phone:630-668-0100
Mailing Address - Fax:630-668-4873
Practice Address - Street 1:101 E COLE AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3105
Practice Address - Country:US
Practice Address - Phone:630-668-0100
Practice Address - Fax:630-668-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty