Provider Demographics
NPI:1447572003
Name:VALLEY DENTAL CARE OF PLAINFIELD
Entity Type:Organization
Organization Name:VALLEY DENTAL CARE OF PLAINFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-803-6431
Mailing Address - Street 1:3405 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-5005
Mailing Address - Country:US
Mailing Address - Phone:630-551-7000
Mailing Address - Fax:
Practice Address - Street 1:2356 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-7756
Practice Address - Country:US
Practice Address - Phone:630-436-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190266121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty