Provider Demographics
NPI:1023293263
Name:DENTISTRY FOR ALL AGES INC.
Entity type:Organization
Organization Name:DENTISTRY FOR ALL AGES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LEISCHNER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-439-2445
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 660
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-439-2445
Mailing Address - Fax:847-439-2444
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 660
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-439-2445
Practice Address - Fax:847-439-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty