Provider Demographics
NPI:1215190012
Name:DUNDEE SMILE CENTER, LTD.
Entity type:Organization
Organization Name:DUNDEE SMILE CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-961-5732
Mailing Address - Street 1:201 PENNY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1431
Mailing Address - Country:US
Mailing Address - Phone:847-428-8700
Mailing Address - Fax:847-428-8703
Practice Address - Street 1:201 PENNY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1431
Practice Address - Country:US
Practice Address - Phone:847-428-8700
Practice Address - Fax:847-428-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental