Healthcare Provider Details

I. General information

NPI: 1114551579
Provider Name (Legal Business Name): DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14831 W 159TH ST STE 1
LOCKPORT IL
60491-9008
US

IV. Provider business mailing address

14831 W 159TH ST STE 2
LOCKPORT IL
60491-9008
US

V. Phone/Fax

Practice location:
  • Phone: 630-218-1920
  • Fax: 815-744-7059
Mailing address:
  • Phone: 630-218-1920
  • Fax: 815-744-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD ALLEN CRAIG
Title or Position: PRESIDENT
Credential: DDS
Phone: 312-676-9892