Provider Demographics
NPI:1972059368
Name:DEMAS DENTAL PC
Entity type:Organization
Organization Name:DEMAS DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-692-6800
Mailing Address - Street 1:111 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4203
Mailing Address - Country:US
Mailing Address - Phone:847-692-6800
Mailing Address - Fax:847-692-6336
Practice Address - Street 1:111 S WASHINGTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4203
Practice Address - Country:US
Practice Address - Phone:847-692-6800
Practice Address - Fax:847-692-6336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEMAS DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190282601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty