Provider Demographics
NPI:1316110596
Name:JUST KIDS DENTAL
Entity type:Organization
Organization Name:JUST KIDS DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENSADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-772-2545
Mailing Address - Street 1:3021 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6569
Mailing Address - Country:US
Mailing Address - Phone:773-772-2545
Mailing Address - Fax:773-772-2555
Practice Address - Street 1:3021 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6569
Practice Address - Country:US
Practice Address - Phone:773-772-2545
Practice Address - Fax:773-772-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0255661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty