Organization
CRESCENT FAMILY DENTAL LLC
Active
Other names
Crescent Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEEPTHA SURAMPUDI DDS (PRESIDENT)
(224) 229-9688
Entity
Organization
Contact information
Practice address
307 S MILWAUKEE AVE STE 101, WHEELING, IL 60090-5035
(847) 459-3366
Mailing address
180 BROOK HILL LN, VERNON HILLS, IL 60061-3142
(224) 229-9688
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.030051
IL
Other
Enumeration date
06/10/2017
Last updated
06/25/2020
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