Provider Demographics
NPI:1730333972
Name:ILLINOIS DENTAL ARTS P.C.
Entity type:Organization
Organization Name:ILLINOIS DENTAL ARTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VLAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-246-1666
Mailing Address - Street 1:5600 SOUTH WOLF ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5600 SOUTH WOLF ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-2254
Practice Address - Country:US
Practice Address - Phone:708-246-1666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty