Provider Demographics
NPI:1932643210
Name:H & H FAMILY DENTAL, PC
Entity Type:Organization
Organization Name:H & H FAMILY DENTAL, PC
Other - Org Name:HOLMES DENTAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-662-0523
Mailing Address - Street 1:1190 E PERSHING RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4753
Mailing Address - Country:US
Mailing Address - Phone:217-872-2791
Mailing Address - Fax:217-872-4653
Practice Address - Street 1:1190 E PERSHING RD
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4753
Practice Address - Country:US
Practice Address - Phone:217-872-2791
Practice Address - Fax:217-872-4653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H & H FAMILY DENTAL DECATUR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-06
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0255051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL33486OtherBC/BS ID#