Provider Demographics
NPI:1801301395
Name:DOWNTOWN TINLEY DENTAL PC
Entity type:Organization
Organization Name:DOWNTOWN TINLEY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-258-9646
Mailing Address - Street 1:608 HONS BRINKER CT.
Mailing Address - Street 2:
Mailing Address - City:PEOTONE
Mailing Address - State:IL
Mailing Address - Zip Code:60468
Mailing Address - Country:US
Mailing Address - Phone:708-258-9646
Mailing Address - Fax:708-258-6981
Practice Address - Street 1:17859 OAK PARK AVENUE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477
Practice Address - Country:US
Practice Address - Phone:708-532-0091
Practice Address - Fax:708-258-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental