Healthcare Provider Details

I. General information

NPI: 1356917264
Provider Name (Legal Business Name): CHARLIE JORDAN HOBBS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 LACEY RD
DOWNERS GROVE IL
60515-5430
US

IV. Provider business mailing address

3450 LACEY RD
DOWNERS GROVE IL
60515-5430
US

V. Phone/Fax

Practice location:
  • Phone: 630-743-4500
  • Fax:
Mailing address:
  • Phone: 630-743-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.033089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: