1316221351 NPI number — HELPING HANDS DENTAL SERVICES, NFP

Table of content: (NPI 1316221351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316221351 NPI number — HELPING HANDS DENTAL SERVICES, NFP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HELPING HANDS DENTAL SERVICES, NFP
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:
THAT'S THE TOOTH
Provider Other Organization Name Type Code:
3
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:
1316221351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9249 S CICERO AVE STE 331
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453-9700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-778-1125
Provider Business Mailing Address Fax Number:
773-912-6804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2447 W 79TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60652-1734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-776-1285
Provider Business Practice Location Address Fax Number:
773-776-3171
Provider Enumeration Date:
10/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-778-1125

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  019022143 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1002342 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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