OLD TOWN DENTAL CENTER NPI 1659696995

NPI Information

NPI: 1659696995
Provider Name: OLD TOWN DENTAL CENTER
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
333 W NORTH AVE
CHICAGO, IL
ZIP 60610
Phone: (312) 751-1113
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OLD TOWN DENTAL CENTER is a dental clinic center in Chicago, IL. OLD TOWN DENTAL CENTER NPI is 1659696995. The provider is registered as an organization entity type.

The provider's business location address is:

333 W NORTH AVE
CHICAGO, IL
ZIP 60610-293
Phone: (312) 751-1113

The provider's authorized official is Vlad Ferdkoff .
The authorized official title is President and has the following contact phone number (312) 751-1113.

The enumeration date for this NPI number is 3/30/2010 and was last updated on 3/30/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	019024754	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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