Provider Demographics
NPI:1780092437
Name:KIDS PLUS PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:KIDS PLUS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-243-6200
Mailing Address - Street 1:15900 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-2910
Mailing Address - Country:US
Mailing Address - Phone:630-243-6200
Mailing Address - Fax:630-733-2448
Practice Address - Street 1:15900 W 127TH ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2910
Practice Address - Country:US
Practice Address - Phone:630-243-6200
Practice Address - Fax:630-733-2448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS PLUS PEDIATRIC DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190238921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty