OrganizationActive
Modern Dental of Logan Square LLC
NPI 1639625437 · General Practice Dentistry · Chicago, IL
Provider details
- NPI number
- 1639625437
- Entity type
- Organization
- Primary specialty
- General Practice DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Phillip Palella, Owner(773) 489-5700
- License
- 019026403 (IL)
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(71/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 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
2645 N Milwaukee
Chicago, IL 60647
Phone: (773) 717-5509
Street-level locationGet directions
Mailing address
2037 W Division
Chicago, IL 60622
Registry dates
- Enumerated
- 2016-08-31
- Last updated
- 2016-08-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.