Provider Demographics
NPI:1841331154
Name:DENTISTS OF HINSDALE LAKE
Entity type:Organization
Organization Name:DENTISTS OF HINSDALE LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY - TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-323-5333
Mailing Address - Street 1:6300 KINGERY HWY
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6300 KINGERY HWY
Practice Address - Street 2:SUITE 216
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2248
Practice Address - Country:US
Practice Address - Phone:630-323-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty