Provider Demographics
NPI:1831476183
Name:MY FAMILY DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:MY FAMILY DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CERTEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-456-3832
Mailing Address - Street 1:6223 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2818
Mailing Address - Country:US
Mailing Address - Phone:224-534-7123
Mailing Address - Fax:224-534-7214
Practice Address - Street 1:6223 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2818
Practice Address - Country:US
Practice Address - Phone:224-534-7123
Practice Address - Fax:224-534-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019018019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty