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MODERN DENTAL OF LOGAN SQUARE LLC
NPI 1639625437
Dentist - General Practice in Chicago, IL

Active since August 31, 2016
2645 N MILWAUKEE, CHICAGO, IL 60647(773) 717-5509 Get Directions Write a Review

NPPES record last updated: August 31, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Modern Dental Of Logan Square Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MODERN DENTAL OF LOGAN SQUARE LLC (NPI 1639625437) is a healthcare organization registered as a general practice in Chicago, Illinois and active in the NPI registry since August 2016. The organization lists Phillip Palella, Owner, as its authorized official.

NPPES Registry Identity

NPI1639625437
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameMODERN DENTAL OF LOGAN SQUARE LLC
Location Address2645 N MILWAUKEEChicago, IL 60647
Mailing Address2037 W DivisionChicago, IL 60622 · (773) 489-5700
Phone(773) 717-5509
Organization SubpartNo
Authorized OfficialPhillip PalellaOwner · (773) 489-5700
Enumeration DateAugust 31, 2016
✔ NPI 1639625437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in IL · 019026403
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
2645 N MILWAUKEE, Chicago, IL 60647
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Modern Dental Of Logan Square LLC's NPI number?

The NPI number for Modern Dental Of Logan Square LLC is 1639625437. It was assigned to this organization in the NPPES registry on August 31, 2016.

Where is Modern Dental Of Logan Square LLC located?

Modern Dental Of Logan Square LLC is located at 2645 N Milwaukee, Chicago, IL 60647. The listed phone number is (773) 717-5509.

What is Modern Dental Of Logan Square LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Modern Dental Of Logan Square LLC was last updated on August 31, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.