Provider Demographics
NPI:1760501860
Name:PICCHETTI DENTAL CARE
Entity Type:Organization
Organization Name:PICCHETTI DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PICCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-627-7651
Mailing Address - Street 1:660 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4776
Mailing Address - Country:US
Mailing Address - Phone:630-627-7651
Mailing Address - Fax:630-627-7747
Practice Address - Street 1:660 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4776
Practice Address - Country:US
Practice Address - Phone:630-627-7651
Practice Address - Fax:630-627-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
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