Provider Demographics
NPI:1669748430
Name:COURTNEY R VILLARI DDS
Entity type:Organization
Organization Name:COURTNEY R VILLARI DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:VILLARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-689-0419
Mailing Address - Street 1:7700 MADISON ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2102
Mailing Address - Country:US
Mailing Address - Phone:708-689-0419
Mailing Address - Fax:708-689-0687
Practice Address - Street 1:7700 MADISON ST
Practice Address - Street 2:SUITE #1
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2102
Practice Address - Country:US
Practice Address - Phone:708-689-0419
Practice Address - Fax:708-689-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty