Provider Demographics
NPI:1386201622
Name:PROGRESSIVE DENTAL & ASSOCIATES, PC
Entity type:Organization
Organization Name:PROGRESSIVE DENTAL & ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DERELL
Authorized Official - Last Name:DURR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-747-4294
Mailing Address - Street 1:20402 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1734
Mailing Address - Country:US
Mailing Address - Phone:708-747-4294
Mailing Address - Fax:708-747-5223
Practice Address - Street 1:20402 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-1734
Practice Address - Country:US
Practice Address - Phone:708-747-4294
Practice Address - Fax:708-747-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies