MEDICARE: DENTAL EXPERTS, 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	019024846	IL

General Provider Information

NPI Number	:	1154592145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL EXPERTS, LLC

Provider Business Mailing Address
First Line	:	12200 SOUTH WESTERN AVE
Second Line	:	STE 108
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-1493
Country	:	US
Telephone Number	:	708-385-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	12200 SOUTH WESTERN AVE
Second Line	:	STE 108
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-1493
Country	:	US
Telephone Number	:	708-385-3700
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING & ENROLLMENT
Name	:	CHLOE DECOSTER
Credential	:
Telephone Number	:	312-274-4529

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	04/06/2026

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Directions to “DENTAL EXPERTS, LLC ” Practice Location

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