Provider Demographics
NPI:1912163437
Name:QUALITY DENTAL, INC
Entity Type:Organization
Organization Name:QUALITY DENTAL, INC
Other - Org Name:QUALITY DENTAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-201-1072
Mailing Address - Street 1:1121 E. SIBLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419
Mailing Address - Country:US
Mailing Address - Phone:708-201-1072
Mailing Address - Fax:708-201-1010
Practice Address - Street 1:1121 E. SIBLEY BLVD
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419
Practice Address - Country:US
Practice Address - Phone:708-201-1072
Practice Address - Fax:708-201-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190241951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty