Provider Demographics
NPI:1982889994
Name:BURLINGTON DENTAL CARE, LLC
Entity type:Organization
Organization Name:BURLINGTON DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TERESE-KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-325-9298
Mailing Address - Street 1:235 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1148
Mailing Address - Country:US
Mailing Address - Phone:630-325-9298
Mailing Address - Fax:
Practice Address - Street 1:235 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1148
Practice Address - Country:US
Practice Address - Phone:630-325-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental