Organization
LEMONT FAMILY DENTAL, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER L SPLITT-KRULL DDS (PRESIDENT)
(630) 257-8669
Entity
Organization
Contact information
Practice address
160 E WEND ST STE B, LEMONT, IL 60439-2904
(630) 257-8669
(630) 257-9255
Mailing address
160 E WEND ST STE B, LEMONT, IL 60439-2904
(630) 257-8669
(630) 257-9255
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-022298
IL
332B00000X
Durable Medical Equipment & Medical Supplies
019022298
IL
332BC3200X
Customized Equipment (DME)
019022298
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6987150001
PTAN
IL
Enumeration date
12/06/2013
Last updated
09/09/2015
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