Provider Demographics
NPI:1225387574
Name:A TOUCH OF CLASS DENTISTRY II
Entity type:Organization
Organization Name:A TOUCH OF CLASS DENTISTRY II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-371-9373
Mailing Address - Street 1:12033 S. PULASKI ROAD
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803
Mailing Address - Country:US
Mailing Address - Phone:708-371-9373
Mailing Address - Fax:708-371-9424
Practice Address - Street 1:12033 S. PULASKI ROAD
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803
Practice Address - Country:US
Practice Address - Phone:708-371-9373
Practice Address - Fax:708-371-9424
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A TOUCH OF CLASS DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-31
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190241951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty