Provider Demographics
NPI:1255116463
Name:HICKORY HILLS DENTAL CENTER
Entity type:Organization
Organization Name:HICKORY HILLS DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-926-4600
Mailing Address - Street 1:10S411 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6856
Mailing Address - Country:US
Mailing Address - Phone:630-999-9260
Mailing Address - Fax:
Practice Address - Street 1:6735 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2112
Practice Address - Country:US
Practice Address - Phone:708-598-0717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty