Provider Demographics
NPI:1861668600
Name:FAMILY DENTISTRY, LTD
Entity Type:Organization
Organization Name:FAMILY DENTISTRY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JODWALIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-243-1010
Mailing Address - Street 1:15543 E 127TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8584
Mailing Address - Country:US
Mailing Address - Phone:630-243-1010
Mailing Address - Fax:630-243-1017
Practice Address - Street 1:15543 E 127TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-8584
Practice Address - Country:US
Practice Address - Phone:630-243-1010
Practice Address - Fax:630-243-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190231751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty