Provider Demographics
NPI:1932370111
Name:ELGIN DENTAL PROFILE LTD.
Entity Type:Organization
Organization Name:ELGIN DENTAL PROFILE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RONCEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-516-0000
Mailing Address - Street 1:373 SUMMIT ST
Mailing Address - Street 2:STE 108
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3733
Mailing Address - Country:US
Mailing Address - Phone:847-888-9000
Mailing Address - Fax:847-888-9321
Practice Address - Street 1:373 SUMMIT ST
Practice Address - Street 2:STE 108
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3733
Practice Address - Country:US
Practice Address - Phone:847-888-9000
Practice Address - Fax:847-888-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty