Provider Demographics
NPI:1104541622
Name:PREMIER DENTISTRY AT MILLENNIUM PARK LLC
Entity type:Organization
Organization Name:PREMIER DENTISTRY AT MILLENNIUM PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NECHAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-726-1901
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1503
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-726-1901
Mailing Address - Fax:312-377-5053
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1503
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-726-1901
Practice Address - Fax:312-377-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty