Organization
32 DENTAL SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA HERNANDEZ (RCM AND CREDENTIALING MANAGER)
(331) 645-5299
Entity
Organization
Contact information
Practice address
640 OGDEN AVE STE E, DOWNERS GROVE, IL 60515-2972
(331) 291-5021
Mailing address
640 OGDEN AVE STE E, DOWNERS GROVE, IL 60515-2972
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/20/2026
Last updated
03/20/2026
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