Provider Demographics
NPI:1154530459
Name:TOWN CENTRE DENTAL GROUP, LTD.
Entity type:Organization
Organization Name:TOWN CENTRE DENTAL GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-328-1180
Mailing Address - Street 1:636 CHURCH ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4508
Mailing Address - Country:US
Mailing Address - Phone:847-328-1180
Mailing Address - Fax:847-328-1189
Practice Address - Street 1:636 CHURCH ST
Practice Address - Street 2:SUITE 309
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4508
Practice Address - Country:US
Practice Address - Phone:847-328-1180
Practice Address - Fax:847-328-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty