Provider Demographics
NPI:1811985294
Name:UNIVERSITY ASSOCIATES IN DENTISTRY, LTD.
Entity type:Organization
Organization Name:UNIVERSITY ASSOCIATES IN DENTISTRY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-704-5511
Mailing Address - Street 1:680 N LASALLE ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3723
Mailing Address - Country:US
Mailing Address - Phone:312-704-5511
Mailing Address - Fax:312-346-3991
Practice Address - Street 1:680 N LASALLE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3723
Practice Address - Country:US
Practice Address - Phone:312-704-5511
Practice Address - Fax:312-346-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty