Provider Demographics
NPI:1114551579
Name:DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD
Entity Type:Organization
Organization Name:DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD
Other - Org Name:MIDWEST DENTAL SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-676-9892
Mailing Address - Street 1:14831 W 159TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9008
Mailing Address - Country:US
Mailing Address - Phone:630-218-1920
Mailing Address - Fax:815-744-7059
Practice Address - Street 1:14831 W 159TH ST STE 1
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60491-9008
Practice Address - Country:US
Practice Address - Phone:630-218-1920
Practice Address - Fax:815-744-7059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-25
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124041769OtherNPI RICHARD CRAIG DDS
1265442073OtherNPI BRIAN PRENTICE DDS
1447468178OtherNPI IVAN VALCARENGHI DDS
1053453936OtherNPI STEVEN MORAVEC DDS
1053423285OtherNPI KEVIN WALLACE DMD
1457579682OtherNPI CHARLES LOCKHART DDS