Healthcare Provider Details

I. General information

NPI: 1114550043
Provider Name (Legal Business Name): 1ST FAMILY DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1496 MERCHANT DR
ALGONQUIN IL
60102-5917
US

IV. Provider business mailing address

4901 N KEDZIE AVE
CHICAGO IL
60625-5009
US

V. Phone/Fax

Practice location:
  • Phone: 847-845-2970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VESNA BELKIC
Title or Position: COO
Credential:
Phone: 773-340-8318