Provider Demographics
NPI:1588109151
Name:ADVOCATE DENTAL CENTER
Entity type:Organization
Organization Name:ADVOCATE DENTAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, DENTAL PROGRAMS
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, MBA
Authorized Official - Phone:773-296-8189
Mailing Address - Street 1:913 W WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6709
Mailing Address - Country:US
Mailing Address - Phone:773-871-1461
Mailing Address - Fax:773-871-6353
Practice Address - Street 1:913 W WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6709
Practice Address - Country:US
Practice Address - Phone:773-871-1461
Practice Address - Fax:773-871-6353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCATE HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-05
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental