Provider Demographics
NPI:1912278235
Name:AJ TROTTA DDS & ASSOCIATES LTD
Entity Type:Organization
Organization Name:AJ TROTTA DDS & ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-545-2881
Mailing Address - Street 1:4224 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2729
Mailing Address - Country:US
Mailing Address - Phone:773-545-2881
Mailing Address - Fax:773-545-1142
Practice Address - Street 1:4224 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2729
Practice Address - Country:US
Practice Address - Phone:773-545-2881
Practice Address - Fax:773-545-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19014696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty