Provider Demographics
NPI:1750503371
Name:AFFORDABLE DENTISTRY TODAY, PC
Entity type:Organization
Organization Name:AFFORDABLE DENTISTRY TODAY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:I & R SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5170
Mailing Address - Street 1:615 SOUTH RANDALL ROAD, UNIT #110
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1564
Mailing Address - Country:US
Mailing Address - Phone:630-443-6635
Mailing Address - Fax:630-443-6637
Practice Address - Street 1:615 SOUTH RANDALL ROAD, UNIT #110
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1564
Practice Address - Country:US
Practice Address - Phone:630-443-6635
Practice Address - Fax:630-443-6637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFORDABLE DENTISTRY TODAY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
IL0190295091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty