Provider Demographics
NPI:1831264704
Name:FAMILY CHOICE DENTAL INC.
Entity type:Organization
Organization Name:FAMILY CHOICE DENTAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOS-KOLODZIEJCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-521-8889
Mailing Address - Street 1:1332 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-1762
Mailing Address - Country:US
Mailing Address - Phone:630-521-8889
Mailing Address - Fax:630-521-8892
Practice Address - Street 1:1332 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-1762
Practice Address - Country:US
Practice Address - Phone:630-521-8889
Practice Address - Fax:630-521-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental