Provider Demographics
NPI:1477603025
Name:VILLAGE GREEN DENTAL CENTER
Entity Type:Organization
Organization Name:VILLAGE GREEN DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GARDNER
Authorized Official - Last Name:HUTCHINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-851-0710
Mailing Address - Street 1:2853 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9059
Mailing Address - Country:US
Mailing Address - Phone:630-851-0710
Mailing Address - Fax:630-851-0431
Practice Address - Street 1:2853 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9059
Practice Address - Country:US
Practice Address - Phone:630-851-0710
Practice Address - Fax:630-851-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty