Provider Demographics
NPI:1740959345
Name:EDC OF LEMONT PLLC
Entity type:Organization
Organization Name:EDC OF LEMONT PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KHURANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-399-9595
Mailing Address - Street 1:15543 E 127TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8584
Mailing Address - Country:US
Mailing Address - Phone:630-243-8300
Mailing Address - Fax:630-243-9493
Practice Address - Street 1:15543 E 127TH ST STE 103
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-8584
Practice Address - Country:US
Practice Address - Phone:630-243-8300
Practice Address - Fax:630-243-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty