MEDICARE: VILLAGE DENTISTRY 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	122300000X	Dentist

General Provider Information

NPI Number	:	1548142854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE DENTISTRY LLC

Provider Business Mailing Address
First Line	:	1S132 SUMMIT AVE STE 102
Second Line	:
City	:	OAKBROOK TERRACE
State	:	IL
Zip	:	60181-3931
Country	:	US
Telephone Number	:	630-247-7216
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3811
Country	:	US
Telephone Number	:	773-579-0500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRASANTH DOMMARAJU
Credential	:	DMD
Telephone Number	:	630-247-7216

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/25/2025

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Directions to “VILLAGE DENTISTRY LLC ” Practice Location

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