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General NPI Number Information
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NPI Number | 1548142854
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Entity Type | Organization
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Legal Business Name | VILLAGE DENTISTRY LLC
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 2345 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-3811
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Country | US
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Telephone | 773-579-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 1S132 SUMMIT AVE STE 102
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-3931
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Country | US
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Telephone | 630-247-7216
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PRASANTH DOMMARAJU
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Credential | DMD
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Telephone | 630-247-7216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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