Provider Demographics
NPI:1881859197
Name:KIDS FIRST PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:KIDS FIRST PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KARSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-717-5437
Mailing Address - Street 1:1534 WEATHERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2019
Mailing Address - Country:US
Mailing Address - Phone:847-717-5437
Mailing Address - Fax:
Practice Address - Street 1:1534 WEATHERSTON CT.
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2019
Practice Address - Country:US
Practice Address - Phone:847-717-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027105302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherDENTAL SPECIALTY