Provider Demographics
NPI:1386736346
Name:DUPAGE DENTAL PC
Entity type:Organization
Organization Name:DUPAGE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-579-1600
Mailing Address - Street 1:636 RAYMOND DR
Mailing Address - Street 2:102
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-579-1600
Mailing Address - Fax:630-579-0022
Practice Address - Street 1:636 RAYMOND DR
Practice Address - Street 2:102
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-579-1600
Practice Address - Fax:630-579-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty