Provider Demographics
NPI:1790998748
Name:DENTAL DESIGN GROUP, INC
Entity Type:Organization
Organization Name:DENTAL DESIGN GROUP, INC
Other - Org Name:SMILE DESIGNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-355-9010
Mailing Address - Street 1:1000 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8616
Mailing Address - Country:US
Mailing Address - Phone:630-355-9010
Mailing Address - Fax:630-355-9926
Practice Address - Street 1:1000 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8616
Practice Address - Country:US
Practice Address - Phone:630-355-9010
Practice Address - Fax:630-355-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0227791223G0001X
IL019-0250991223G0001X
IL021-0020281223P0300X
IL021-0012001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty