Provider Demographics
NPI:1801963558
Name:LINCOLNWAY DENTAL CENTER, PC
Entity type:Organization
Organization Name:LINCOLNWAY DENTAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:MOON
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-897-1300
Mailing Address - Street 1:417 S LINCOLNWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-5109
Mailing Address - Country:US
Mailing Address - Phone:630-897-1300
Mailing Address - Fax:630-897-7172
Practice Address - Street 1:417 S LINCOLNWAY
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-5109
Practice Address - Country:US
Practice Address - Phone:630-897-1300
Practice Address - Fax:630-897-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190226941223G0001X
IL0190247041223G0001X
IL0190203751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty