Provider Demographics
NPI:1205526035
Name:LUIS GRANADOS DDS PC
Entity type:Organization
Organization Name:LUIS GRANADOS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANADOS PAUCAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-474-0976
Mailing Address - Street 1:1660 GLEN ELLYN RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2504
Mailing Address - Country:US
Mailing Address - Phone:630-474-0976
Mailing Address - Fax:
Practice Address - Street 1:1660 GLEN ELLYN RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-2504
Practice Address - Country:US
Practice Address - Phone:630-474-0976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental