Provider Demographics
NPI:1528354784
Name:DECISIVE EDGE, P.C.
Entity type:Organization
Organization Name:DECISIVE EDGE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIBORIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-424-6401
Mailing Address - Street 1:7110 WEST ARCHER AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638
Mailing Address - Country:US
Mailing Address - Phone:773-586-5522
Mailing Address - Fax:773-586-5534
Practice Address - Street 1:7110 WEST ARCHER AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638
Practice Address - Country:US
Practice Address - Phone:773-586-5522
Practice Address - Fax:773-586-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty