Provider Demographics
NPI:1740407410
Name:CARRON AND HODACK DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:CARRON AND HODACK DENTAL ASSOCIATES LLC
Other - Org Name:RIDGEPOINTE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARRON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-854-8555
Mailing Address - Street 1:152 N RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4471
Mailing Address - Country:US
Mailing Address - Phone:847-854-8555
Mailing Address - Fax:847-854-7093
Practice Address - Street 1:152 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4471
Practice Address - Country:US
Practice Address - Phone:847-854-8555
Practice Address - Fax:847-854-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
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