Provider Demographics
NPI:1952890691
Name:DENTIST ON THE PARK, INC.
Entity Type:Organization
Organization Name:DENTIST ON THE PARK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHOENING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:872-888-9010
Mailing Address - Street 1:8 S MICHIGAN AVE STE 1306
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3377
Mailing Address - Country:US
Mailing Address - Phone:872-888-9010
Mailing Address - Fax:872-888-9015
Practice Address - Street 1:8 S MICHIGAN AVE STE 1306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3377
Practice Address - Country:US
Practice Address - Phone:872-888-9010
Practice Address - Fax:872-888-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029186261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental