Provider Demographics
NPI:1053755801
Name:CHICAGO DENTAL PARTNERS, LLC
Entity type:Organization
Organization Name:CHICAGO DENTAL PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-580-3334
Mailing Address - Street 1:2551 N CLARK ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1798
Mailing Address - Country:US
Mailing Address - Phone:773-580-3334
Mailing Address - Fax:
Practice Address - Street 1:2551 N CLARK ST
Practice Address - Street 2:SUITE 600
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1798
Practice Address - Country:US
Practice Address - Phone:773-580-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-027405251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare