MEDICARE: 32 VILLAGE DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1063387710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	32 VILLAGE DENTAL LLC

Provider Business Mailing Address
First Line	:	958 ELK GROVE TOWN CTR
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3754
Country	:	US
Telephone Number	:	847-469-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	958 ELK GROVE TOWN CTR
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3754
Country	:	US
Telephone Number	:	847-364-5100
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER SUPPORT
Name	:	MRS. SAMANTHA HERNANDEZ
Credential	:
Telephone Number	:	847-469-4340

Provider Enumeration Date	:	10/10/2025
Last Update Date	:	05/12/2026

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Directions to “32 VILLAGE DENTAL LLC ” Practice Location

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