Provider Demographics
NPI:1225203953
Name:BRENTWOOD FAMILY DENTAL
Entity Type:Organization
Organization Name:BRENTWOOD FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THIRUNINDRAVUR
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAMADORAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-694-4937
Mailing Address - Street 1:1145 S YORK RD
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3342
Mailing Address - Country:US
Mailing Address - Phone:630-694-4937
Mailing Address - Fax:630-694-9953
Practice Address - Street 1:1145 S YORK RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3342
Practice Address - Country:US
Practice Address - Phone:630-694-4937
Practice Address - Fax:630-694-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190253571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty