Provider Demographics
NPI:1225344112
Name:1ST FAMILY DENTAL OF ROSELLE INC.
Entity Type:Organization
Organization Name:1ST FAMILY DENTAL OF ROSELLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELKIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-340-8318
Mailing Address - Street 1:803 E NERGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-4817
Mailing Address - Country:US
Mailing Address - Phone:630-351-1111
Mailing Address - Fax:630-351-1115
Practice Address - Street 1:803 E NERGE RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-4817
Practice Address - Country:US
Practice Address - Phone:630-351-1111
Practice Address - Fax:630-351-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty