# PROFESSIONAL DENTAL ALLIANCE OF ILLINOIS SPECIALTY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Associated Dental Specialists of Long Grove
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558145227
- **Authorized official:** ERICA QUINTEROS (CREDENTIALING)
- **Authorized official phone:** (724) 901-1964

## Contact information

- **Practice address:** 4160 IL ROUTE 83 STE 308, LONG GROVE, IL 60047-8034
- **Practice address phone:** (847) 634-6166
- **Mailing address:** 125 ENTERPRISE DR STE 200, PITTSBURGH, PA 15275-1223
- **Mailing address phone:** (249) 011-9647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 08/23/2023
- **Last updated:** 12/13/2023