Provider Demographics
NPI:1649441932
Name:AYA DENTAL
Entity type:Organization
Organization Name:AYA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RONCEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-516-0000
Mailing Address - Street 1:2955 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5348
Mailing Address - Country:US
Mailing Address - Phone:773-286-5551
Mailing Address - Fax:773-286-5552
Practice Address - Street 1:2955 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5348
Practice Address - Country:US
Practice Address - Phone:773-286-5551
Practice Address - Fax:773-286-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty