Provider Demographics
NPI:1104139096
Name:ATLAS DENTAL CORP
Entity type:Organization
Organization Name:ATLAS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-261-5208
Mailing Address - Street 1:7714 SOUTH CICERO AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1583
Mailing Address - Country:US
Mailing Address - Phone:708-636-3368
Mailing Address - Fax:
Practice Address - Street 1:7714 SOUTH CICERO AVENUE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1583
Practice Address - Country:US
Practice Address - Phone:708-636-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190282751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty