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General NPI Number Information
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NPI Number | 1417773920
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Entity Type | Organization
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Legal Business Name | 956 DEERFIELD STO LLC
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Dates
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Enumeration Date | 11/29/2024
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 956 DEERFIELD RD UNIT B
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City | DEERFIELD
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State | IL
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Zip | 60015-4155
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Country | US
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Telephone | 847-940-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 N PLUM GROVE RD UNIT 147
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4857
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA VILLAFANE-SWABY
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Credential | DMD
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Telephone | 630-532-0207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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