Provider Demographics
NPI:1336210210
Name:LEMONT FAMILY DENTAL LTD
Entity Type:Organization
Organization Name:LEMONT FAMILY DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPLITT KRULL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-257-8669
Mailing Address - Street 1:160-B EAST WEND ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439
Mailing Address - Country:US
Mailing Address - Phone:630-257-8669
Mailing Address - Fax:630-257-9255
Practice Address - Street 1:160-B EAST WEND ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439
Practice Address - Country:US
Practice Address - Phone:630-257-8669
Practice Address - Fax:630-257-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBS27161621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty