Healthcare Provider Details

I. General information

NPI: 1558984427
Provider Name (Legal Business Name): DECKER FAMILY DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 W 103RD ST STE 1D
OAK LAWN IL
60453-4792
US

IV. Provider business mailing address

4647 W 103RD ST STE 1D
OAK LAWN IL
60453-4792
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-6500
  • Fax:
Mailing address:
  • Phone: 708-422-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VILIJA MCWILLIAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-422-6500