Provider Demographics
NPI:1275655037
Name:HOMETOWN DENTAL CARE PC
Entity Type:Organization
Organization Name:HOMETOWN DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-424-8110
Mailing Address - Street 1:4084 SOUTHWEST HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HOMETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:60456-1100
Mailing Address - Country:US
Mailing Address - Phone:708-424-8110
Mailing Address - Fax:708-425-3878
Practice Address - Street 1:4084 SOUTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:HOMETOWN
Practice Address - State:IL
Practice Address - Zip Code:60456-1100
Practice Address - Country:US
Practice Address - Phone:708-424-8110
Practice Address - Fax:708-425-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
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