Provider Demographics
NPI:1689934754
Name:WEST SUBURBAN FAMILY DENTAL
Entity Type:Organization
Organization Name:WEST SUBURBAN FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-571-3030
Mailing Address - Street 1:120 OAK BROOK CENTER MALL
Mailing Address - Street 2:SUITE#802
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1806
Mailing Address - Country:US
Mailing Address - Phone:630-571-3030
Mailing Address - Fax:630-571-1977
Practice Address - Street 1:120 OAK BROOK CENTER MALL
Practice Address - Street 2:SUITE#802
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1806
Practice Address - Country:US
Practice Address - Phone:630-571-3030
Practice Address - Fax:630-571-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty