Provider Demographics
NPI:1720755978
Name:FAMILY DENTAL HINSDALE
Entity Type:Organization
Organization Name:FAMILY DENTAL HINSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-699-3775
Mailing Address - Street 1:14 ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4217
Mailing Address - Country:US
Mailing Address - Phone:630-258-4648
Mailing Address - Fax:610-848-9007
Practice Address - Street 1:522 W CHESTNUT ST STE 1A
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3172
Practice Address - Country:US
Practice Address - Phone:708-699-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental