| Hickory Dentistry Llc | |
|
8071 W 95th St Hickory Hills IL 60457-2241 | |
| (630) 247-7216 | |
| Not Available |
| Full Name | Hickory Dentistry Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8071 W 95th St, Hickory Hills, Illinois |
| Authorized Official Name and Position | Prasanth Dommaraju (OWNER) |
| Authorized Official Contact | 6302477216 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hickory Dentistry Llc 3924 S Archer Ave Unit D Chicago IL 60632-1116 Ph: (773) 819-7101 | Hickory Dentistry Llc 8071 W 95th St Hickory Hills IL 60457-2241 Ph: (630) 247-7216 |
| NPI Number | 1275131948 |
|---|---|
| Provider Enumeration Date | 10/14/2020 |
| Last Update Date | 10/14/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275131948 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
Dentalaveinc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 7608 W 95th St, Hickory Hills, IL 60457 Phone: 708-737-5459 |