Organization
HICKORY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRASANTH DOMMARAJU (OWNER)
(630) 247-7216
Entity
Organization
Contact information
Practice address
9556 S ROBERTS RD, HICKORY HILLS, IL 60457-2239
(708) 608-0095
Mailing address
3924 S ARCHER AVE UNIT D, CHICAGO, IL 60632-1116
(773) 819-7101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
10/14/2020
Last updated
07/25/2025
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