Provider Demographics
NPI:1902339369
Name:ABT DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ABT DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, MSC
Authorized Official - Phone:847-677-2404
Mailing Address - Street 1:4709 GOLF RD
Mailing Address - Street 2:STE 1005
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1231
Mailing Address - Country:US
Mailing Address - Phone:847-677-2404
Mailing Address - Fax:847-677-7432
Practice Address - Street 1:4709 GOLF RD
Practice Address - Street 2:STE 1005
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1231
Practice Address - Country:US
Practice Address - Phone:847-677-2404
Practice Address - Fax:847-677-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0198451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty