OrganizationActive
Dental on 45 Inc
NPI 1184033839 · Dentist · Third Lake, IL
Provider details
- NPI number
- 1184033839
- Entity type
- Organization
- Primary specialty
- DentistDental Providers
- Organization subpart
- No
- Authorized official
- Marlen Fajardo, Office Manager(224) 541-4066
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(75/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
34484 N US Highway 45
Suite C
Third Lake, IL 60030-4038
Phone: (224) 541-4066
Fax: (847) 752-8425
Street-level locationGet directions
Mailing address
34484 N US Highway 45
Third Lake, IL 60030-4038
Registry dates
- Enumerated
- 2014-08-07
- Last updated
- 2014-08-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.