Provider Demographics
NPI:1992880140
Name:ESSENTIAL DENTAL,P.C.
Entity type:Organization
Organization Name:ESSENTIAL DENTAL,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OPHELIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-468-4554
Mailing Address - Street 1:255 E 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2807
Mailing Address - Country:US
Mailing Address - Phone:773-468-4554
Mailing Address - Fax:773-468-4848
Practice Address - Street 1:255 E 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2807
Practice Address - Country:US
Practice Address - Phone:773-468-4554
Practice Address - Fax:773-468-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty