Provider Demographics
NPI:1881168532
Name:DENTAL LOFT KIDS LLC
Entity type:Organization
Organization Name:DENTAL LOFT KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-482-0702
Mailing Address - Street 1:1 W HARRIS AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2497
Mailing Address - Country:US
Mailing Address - Phone:708-482-0702
Mailing Address - Fax:
Practice Address - Street 1:1 W HARRIS AVE STE 2A
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2497
Practice Address - Country:US
Practice Address - Phone:708-482-0702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty