1700902491 NPI number — ANDERSON DENTAL ASSOCIATES LTD

Table of content: (NPI 1700902491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700902491 NPI number — ANDERSON DENTAL ASSOCIATES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON DENTAL ASSOCIATES 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:
Provider Other Organization Name Type Code:
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:
1700902491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1132 WAUKEGAN ROAD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-729-4411
Provider Business Mailing Address Fax Number:
847-729-4421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1132 WAUKEGAN ROAD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-729-4411
Provider Business Practice Location Address Fax Number:
847-729-4421
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEINLEIN
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
DONALD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-729-4411

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , 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)





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