Crescent Family Dental LLC
Dentist in Wheeling, IL. Organization (NPI-2).
NPI number1043749286
StatusActive
Last updated in NPPESJun 25, 2020
Details
- NPI
- 1043749286
- Entity type
- Organization (NPI-2)
- Legal business name
- Crescent Family Dental LLC
- Organization subpart
- No
- Enumeration date
- Jun 10, 2017
- Certification date
- Jun 25, 2020
- Last updated
- Jun 25, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 019.030051 | IL | Yes |
Other names
- Crescent Family Dental (Doing Business As)
Practice location
307 S Milwaukee Ave Ste 101Wheeling, IL 60090-5035
Phone 847-459-3366
Mailing address
180 Brook Hill LnVernon Hills, IL 60061-3142
Phone 224-229-9688
Authorized official
Deeptha Surampudi
President
2242299688
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