Provider Demographics
NPI:1669696456
Name:MEADOW LAKE DENTAL CARE P.C.
Entity type:Organization
Organization Name:MEADOW LAKE DENTAL CARE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-851-5130
Mailing Address - Street 1:3941 75TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7913
Mailing Address - Country:US
Mailing Address - Phone:630-851-5130
Mailing Address - Fax:
Practice Address - Street 1:3941 75TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7913
Practice Address - Country:US
Practice Address - Phone:630-851-5130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty