Provider Demographics
NPI:1154595395
Name:PALATINE NEW AGE DENTAL
Entity type:Organization
Organization Name:PALATINE NEW AGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIKOR
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAPAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-397-5868
Mailing Address - Street 1:2201 PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-9404
Mailing Address - Country:US
Mailing Address - Phone:847-397-5868
Mailing Address - Fax:847-397-6563
Practice Address - Street 1:2201 PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-9404
Practice Address - Country:US
Practice Address - Phone:847-397-5868
Practice Address - Fax:847-397-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty