Provider Demographics
NPI:1750591723
Name:WEST CHICAGO DENTAL CARE, LTD
Entity type:Organization
Organization Name:WEST CHICAGO DENTAL CARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:FORNAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-520-9030
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60186-1078
Mailing Address - Country:US
Mailing Address - Phone:630-520-9030
Mailing Address - Fax:630-520-9033
Practice Address - Street 1:166 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2803
Practice Address - Country:US
Practice Address - Phone:630-520-9030
Practice Address - Fax:630-520-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty