Provider Demographics
NPI:1700938412
Name:HAMILTON LAKES DENTISTRY
Entity Type:Organization
Organization Name:HAMILTON LAKES DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-773-6966
Mailing Address - Street 1:500 PARK BLVD
Mailing Address - Street 2:SUITE 180C
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143
Mailing Address - Country:US
Mailing Address - Phone:630-773-6966
Mailing Address - Fax:630-773-6971
Practice Address - Street 1:500 PARK BLVD
Practice Address - Street 2:SUITE 180C
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143
Practice Address - Country:US
Practice Address - Phone:630-773-6966
Practice Address - Fax:630-773-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILTIN122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty