Provider Demographics
NPI:1003279274
Name:EARLEY FAMILY DENTAL, PC
Entity type:Organization
Organization Name:EARLEY FAMILY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:EARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-301-2220
Mailing Address - Street 1:15748 S BELL RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8400
Mailing Address - Country:US
Mailing Address - Phone:708-301-2220
Mailing Address - Fax:708-301-2194
Practice Address - Street 1:15748 S BELL RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8400
Practice Address - Country:US
Practice Address - Phone:708-301-2220
Practice Address - Fax:708-301-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty