Provider Demographics
NPI:1427443399
Name:BRUCE S. WARDELL DMD, PC
Entity type:Organization
Organization Name:BRUCE S. WARDELL DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-697-0334
Mailing Address - Street 1:1000 GRAND CANYON PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1705
Mailing Address - Country:US
Mailing Address - Phone:847-884-0250
Mailing Address - Fax:847-884-1967
Practice Address - Street 1:1000 GRAND CANYON PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1705
Practice Address - Country:US
Practice Address - Phone:847-884-0250
Practice Address - Fax:847-884-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0023251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty