Provider Demographics
NPI:1952370447
Name:NUGENT AND SACK DDS
Entity Type:Organization
Organization Name:NUGENT AND SACK DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-968-5900
Mailing Address - Street 1:425 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5127
Mailing Address - Country:US
Mailing Address - Phone:630-968-5900
Mailing Address - Fax:
Practice Address - Street 1:425 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5127
Practice Address - Country:US
Practice Address - Phone:630-968-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190187701223G0001X
IL0190180881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty