Provider Demographics
NPI:1871800656
Name:DM FAMILY DENTISTRY INC
Entity type:Organization
Organization Name:DM FAMILY DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-740-8827
Mailing Address - Street 1:1228 N CEDAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-2556
Mailing Address - Country:US
Mailing Address - Phone:847-740-8827
Mailing Address - Fax:847-740-7388
Practice Address - Street 1:1228 N CEDAR LAKE RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-2556
Practice Address - Country:US
Practice Address - Phone:847-740-8827
Practice Address - Fax:847-740-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022762261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental