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OLD TOWN DENTAL CENTER
NPI 1659696995
Clinic/Center - Dental in Chicago, IL

Active since March 30, 2010
333 W NORTH AVE, CHICAGO, IL 60610(312) 751-1113 Get Directions Write a Review

NPPES record last updated: March 30, 2010. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Table of Contents

  1. NPI Profile Information
  2. Primary Taxonomy
  3. Authorized Official
  4. Frequently Asked Questions
  • Organization
  • Clinic/Center
  • Dental

About OLD TOWN DENTAL CENTER

This page provides the complete NPI Profile along with additional information for Old Town Dental Center, a provider established in Chicago, Illinois operating as a Clinic/center, focusing in dental . The healthcare provider is registered in the NPI registry with number 1659696995 assigned on March 2010. The practitioner's primary taxonomy code is 261QD0000X with license number 019024754 (IL). The provider is registered as an organization and their NPI record was last updated 16 years ago. The authorized official of this NPI record is Dr. Vlad Ferdkoff (President)

NPI
1659696995 Verify this NPI
Provider Name
OLD TOWN DENTAL CENTER
Entity Type
Organization
Location Address
333 W NORTH AVE CHICAGO, IL 60610
Location Phone
(312) 751-1113
Mailing Address
333 W NORTH AVE CHICAGO, IL 60610
Mailing Phone
(312) 751-1113
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
03-30-2010
Last Update Date
03-30-2010
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Dental

Taxonomy Code
261QD0000X
Type
Ambulatory Health Care Facilities
License No.
019024754
License State
IL

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

DR. VLAD FERDKOFF

Authorized Official Title
PRESIDENT
Authorized Official Phone
(312) 751-1113

Reviews for OLD TOWN DENTAL CENTER

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Frequently Asked Questions

What is OLD TOWN DENTAL CENTER's NPI number?

The NPI number assigned to this healthcare provider is 1659696995, enumerated as an "organization" on March 30, 2010.

Where is the provider located?

The provider is located at 333 W NORTH AVE CHICAGO, IL 60610 and the phone number is (312) 751-1113.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QD0000X and a focus in Dental.