Provider Demographics
NPI:1164843421
Name:FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CULLINAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-998-1281
Mailing Address - Street 1:908 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4315
Mailing Address - Country:US
Mailing Address - Phone:847-998-1281
Mailing Address - Fax:847-998-1286
Practice Address - Street 1:908 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4315
Practice Address - Country:US
Practice Address - Phone:847-998-1281
Practice Address - Fax:847-998-1286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY DENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-03
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
019027128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty