Provider Demographics
NPI:1811527013
Name:CHICAGO CENTER FOR ADVANCED DENTISTRY
Entity type:Organization
Organization Name:CHICAGO CENTER FOR ADVANCED DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHELKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-704-5511
Mailing Address - Street 1:222 N LASALLE ST 230B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-704-5511
Mailing Address - Fax:312-346-3991
Practice Address - Street 1:222 N LASALLE ST 230B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-704-5511
Practice Address - Fax:312-346-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty