Provider Demographics
NPI:1316131626
Name:PLAINFIELD DENTAL CARE P.C.
Entity type:Organization
Organization Name:PLAINFIELD DENTAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VLAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FERDKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-439-2400
Mailing Address - Street 1:13400 S ROUTE 59 STE Q
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5839
Mailing Address - Country:US
Mailing Address - Phone:815-439-2400
Mailing Address - Fax:815-439-1837
Practice Address - Street 1:13400 S ROUTE 59 STE Q
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5839
Practice Address - Country:US
Practice Address - Phone:815-439-2400
Practice Address - Fax:815-439-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1223G0001X
MA1223G0001X
NY1223G0001X
IL1223G0001X, 1223P0300X, 1223S0112X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty