Provider Demographics
NPI:1215302625
Name:PREFERRED DENTISTRY ASSOCIATES, LLC
Entity type:Organization
Organization Name:PREFERRED DENTISTRY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ARISTIDES
Authorized Official - Last Name:CONTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-869-1029
Mailing Address - Street 1:1029 HOWARD STREET
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202
Mailing Address - Country:US
Mailing Address - Phone:847-869-1029
Mailing Address - Fax:
Practice Address - Street 1:1029 HOWARD STREET
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202
Practice Address - Country:US
Practice Address - Phone:847-869-1029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty