Provider Demographics
NPI:1487911624
Name:PALDENTAL GROUP, PC
Entity type:Organization
Organization Name:PALDENTAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AROON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-717-8793
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9508
Mailing Address - Country:US
Mailing Address - Phone:815-717-8793
Mailing Address - Fax:815-717-8796
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:SUITE 470
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9508
Practice Address - Country:US
Practice Address - Phone:815-717-8793
Practice Address - Fax:815-717-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty