Provider Demographics
NPI:1588367817
Name:BARTLETT IMPLANTS AND DENTURES LLC
Entity type:Organization
Organization Name:BARTLETT IMPLANTS AND DENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-289-5522
Mailing Address - Street 1:300 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6126
Mailing Address - Country:US
Mailing Address - Phone:847-398-0811
Mailing Address - Fax:
Practice Address - Street 1:981 ILLINOIS RTE 59
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103
Practice Address - Country:US
Practice Address - Phone:630-289-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental