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General NPI Number Information
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NPI Number | 1558984427
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Entity Type | Organization
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Legal Business Name | DECKER FAMILY DENTAL, PC
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 4647 W 103RD ST STE 1D
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City | OAK LAWN
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State | IL
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Zip | 60453-4792
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Country | US
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Telephone | 708-422-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 4647 W 103RD ST STE 1D
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City | OAK LAWN
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State | IL
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Zip | 60453-4792
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Country | US
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Telephone | 708-422-6500
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VILIJA MCWILLIAMS
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Credential |
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Telephone | 708-422-6500
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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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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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