Provider Demographics
NPI:1538443890
Name:DENTAL ART CLINIC
Entity type:Organization
Organization Name:DENTAL ART CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:TYLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-590-5200
Mailing Address - Street 1:1512 N ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1011
Mailing Address - Country:US
Mailing Address - Phone:847-590-5200
Mailing Address - Fax:866-226-8343
Practice Address - Street 1:1512 N ELMHURST RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1011
Practice Address - Country:US
Practice Address - Phone:847-590-5200
Practice Address - Fax:866-226-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty