Provider Demographics
NPI:1295003879
Name:BOLINGBROOK DENTAL CARE
Entity Type:Organization
Organization Name:BOLINGBROOK DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-739-5500
Mailing Address - Street 1:136 S BOLINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2852
Mailing Address - Country:US
Mailing Address - Phone:630-739-5500
Mailing Address - Fax:630-739-5505
Practice Address - Street 1:136 S BOLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2852
Practice Address - Country:US
Practice Address - Phone:630-739-5500
Practice Address - Fax:630-739-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty