Provider Demographics
NPI:1467861856
Name:CARILLON FAMILY DENTAL GROUP, PC
Entity Type:Organization
Organization Name:CARILLON FAMILY DENTAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MBA
Authorized Official - Phone:847-833-4955
Mailing Address - Street 1:450 N WEBER RD
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5355
Mailing Address - Country:US
Mailing Address - Phone:815-372-1160
Mailing Address - Fax:
Practice Address - Street 1:450 N WEBER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-5355
Practice Address - Country:US
Practice Address - Phone:815-372-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty