Provider Demographics
NPI:1285070615
Name:OAK MILL DENTAL GROUP CORP
Entity type:Organization
Organization Name:OAK MILL DENTAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-470-0240
Mailing Address - Street 1:7900 N MILWAUKEE AVE STE 2-24
Mailing Address - Street 2:SUITE 224
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3186
Mailing Address - Country:US
Mailing Address - Phone:847-470-0240
Mailing Address - Fax:847-470-2014
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 2-24
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-470-0240
Practice Address - Fax:773-417-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty