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General NPI Number Information
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NPI Number | 1053627315
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Entity Type | Organization
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Legal Business Name | FAMILY ORAL CARE
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 254 COUNTY FARM RD
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City | WEST CHICAGO
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State | IL
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Zip | 60185-1568
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Country | US
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Telephone | 630-876-6000
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Fax | 630-876-6011
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Provider Business Mailing Address
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Address Line | 254 COUNTY FARM RD
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City | WEST CHICAGO
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State | IL
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Zip | 60185-1568
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Country | US
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Telephone | 630-876-6000
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Fax | 630-876-6011
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID HUANG
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Credential | DDS
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Telephone | 630-876-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019025100
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License Number State | IL
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