Provider Demographics
NPI:1972776748
Name:NEW AGE DENTAL LLC
Entity type:Organization
Organization Name:NEW AGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIKOR
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAPAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-967-0400
Mailing Address - Street 1:8930 WAKEGAN RD
Mailing Address - Street 2:110
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2126
Mailing Address - Country:US
Mailing Address - Phone:847-967-0400
Mailing Address - Fax:
Practice Address - Street 1:8930 WAUKEGAN RD
Practice Address - Street 2:SUITE110
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2126
Practice Address - Country:US
Practice Address - Phone:847-967-0400
Practice Address - Fax:847-967-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty