Provider Demographics
NPI:1043959323
Name:LINCOLN PARK CENTER FOR DENTAL ANESTHESIA
Entity type:Organization
Organization Name:LINCOLN PARK CENTER FOR DENTAL ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TENTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-975-1504
Mailing Address - Street 1:16600 107TH CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8898
Mailing Address - Country:US
Mailing Address - Phone:708-403-3355
Mailing Address - Fax:
Practice Address - Street 1:2551 N CLARK ST STE 502
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1798
Practice Address - Country:US
Practice Address - Phone:708-403-3355
Practice Address - Fax:708-403-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental