Provider Demographics
NPI:1356670202
Name:ORCHARD CROSSING FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ORCHARD CROSSING FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GASPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-859-3550
Mailing Address - Street 1:2080 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-1059
Mailing Address - Country:US
Mailing Address - Phone:630-859-3550
Mailing Address - Fax:
Practice Address - Street 1:2080 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-1059
Practice Address - Country:US
Practice Address - Phone:630-859-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty