Provider Demographics
NPI:1023232220
Name:ENDODONTIC ASSOCIATES OF PARK RIDGE LTD
Entity type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF PARK RIDGE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:POLLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-823-4161
Mailing Address - Street 1:111 S WASHINGTON
Mailing Address - Street 2:#202
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-823-4161
Mailing Address - Fax:847-823-4163
Practice Address - Street 1:111 S WASHINGTON
Practice Address - Street 2:#202
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-823-4161
Practice Address - Fax:847-823-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A141371223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty