Provider Demographics
NPI:1255499216
Name:DESIGNDENTAL
Entity Type:Organization
Organization Name:DESIGNDENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-357-3333
Mailing Address - Street 1:55 S MAIN ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5372
Mailing Address - Country:US
Mailing Address - Phone:630-357-3333
Mailing Address - Fax:630-357-3334
Practice Address - Street 1:55 S MAIN ST
Practice Address - Street 2:SUITE 290
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5372
Practice Address - Country:US
Practice Address - Phone:630-357-3333
Practice Address - Fax:630-357-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty