Provider Demographics
NPI:1528485000
Name:AURORA L CICEOVAN DDS,PC
Entity type:Organization
Organization Name:AURORA L CICEOVAN DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AURORA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CICEOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-358-8080
Mailing Address - Street 1:803 KENNICOTT PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-4072
Mailing Address - Country:US
Mailing Address - Phone:847-806-6765
Mailing Address - Fax:
Practice Address - Street 1:1530 E DUNDEE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-8325
Practice Address - Country:US
Practice Address - Phone:847-358-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190240381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty