Provider Demographics
NPI:1538229174
Name:ALLDENTAL PC
Entity type:Organization
Organization Name:ALLDENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-910-4400
Mailing Address - Street 1:7530 WOODWARD AVE
Mailing Address - Street 2:A 1
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:630-910-4400
Mailing Address - Fax:930-910-5680
Practice Address - Street 1:7530 WOODWARD AVE
Practice Address - Street 2:A 1
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517
Practice Address - Country:US
Practice Address - Phone:630-910-4400
Practice Address - Fax:930-910-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103422Medicaid