1235249459 NPI number — THE DENTISTS PLACE LTD

Table of content: (NPI 1235249459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235249459 NPI number — THE DENTISTS PLACE LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DENTISTS PLACE LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REBECCA T REYES-MORROW AND OR RODNEY L MORROW
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235249459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2017 GREENBAY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-689-1213
Provider Business Mailing Address Fax Number:
847-689-1969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2017 GREENBAY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-689-1213
Provider Business Practice Location Address Fax Number:
847-689-1969
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORROW
Authorized Official First Name:
REBECCA T
Authorized Official Middle Name:
REYES
Authorized Official Title or Position:
DENTIST OWNER
Authorized Official Telephone Number:
847-689-1213

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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