Provider Demographics
NPI:1558740373
Name:ALIVIO DENTAL CARE, LLC
Entity Type:Organization
Organization Name:ALIVIO DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAN
Authorized Official - Middle Name:
Authorized Official - Last Name:M
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-884-8174
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-0400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7335 LEMONT RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3808
Practice Address - Country:US
Practice Address - Phone:630-884-8174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service