Provider Demographics
NPI:1407087729
Name:SEMPER DENTAL CENTER LLC
Entity Type:Organization
Organization Name:SEMPER DENTAL CENTER LLC
Other - Org Name:LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-991-0437
Mailing Address - Street 1:9714 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-1787
Mailing Address - Country:US
Mailing Address - Phone:773-732-3408
Mailing Address - Fax:773-925-9289
Practice Address - Street 1:9714 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-1787
Practice Address - Country:US
Practice Address - Phone:773-732-3408
Practice Address - Fax:773-925-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027752261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9219530Medicaid