Provider Demographics
NPI:1669701710
Name:ADVANCED DENTAL AND IMPLANT CARE
Entity type:Organization
Organization Name:ADVANCED DENTAL AND IMPLANT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:POTTORFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-854-1200
Mailing Address - Street 1:2310 HUNTINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-4420
Mailing Address - Country:US
Mailing Address - Phone:847-854-1200
Mailing Address - Fax:
Practice Address - Street 1:2310 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-4420
Practice Address - Country:US
Practice Address - Phone:847-854-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty